Temporal Trends in 30-Day Outcomes After CTO PCI Versus Non-CTO PCI: A Decade-Long Propensity-Matched Analysis

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Background Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions involves greater technical challenges than PCI for non-CTO lesions. Its outcomes in modern practice remain only partially understood. We aimed to evaluate temporal trends and 30-day outcomes in patients undergoing CTO PCI. Methods Using the TriNetX research database, adult patients undergoing PCI for CTO versus non-CTO lesions between January 2014 and November 2025 were propensity score-matched within predefined time frames (2014-2017, 2018-2021, and 2022-November 2025). Outcomes included 30-day all-cause mortality, ischemic stroke, coronary artery bypass graft (CABG), and pericardiocentesis, with temporal trends assessed among CTO PCI patients. Results After matching, there was no significant difference in 30-day mortality (0.72% vs 0.71%) or ischemic stroke (1.64% vs 1.55%) between CTO PCI and non-CTO PCI. CTO PCI was consistently associated with a higher 30-day incidence of CABG compared with non-CTO PCI across all time frames (2014-2017: hazard ratio [HR], 2.54; 95% CI, 1.57-4.12; 2018-2021: HR, 4.22; 95% CI, 2.18-8.14; 2022-November 2025: HR, 3.13; 95% CI, 1.87-5.25), with absolute rates of 0.91% vs 0.28%, respectively, without a statistically significant temporal trend. Pericardiocentesis occurred more frequently after CTO than non-CTO PCI (0.20% vs 0.09%). Conclusions Over more than a decade, there were no significant differences in mortality or ischemic stroke between CTO PCI and non-CTO PCI. CTO PCI was associated with a higher incidence of pericardiocentesis and CABG, although absolute event rates were low and without an observed impact on 30-day mortality.

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