Trends and clinical outcomes of percutaneous coronary intervention for chronic total occlusions: report from the Melbourne Interventional Group.

Abstract

Background: Chronic total occlusion (CTO) interventions are technically challenging, with historically low procedural success rates. Improved technology and innovative techniques have resulted in increased performance of percutaneous coronary intervention (PCI) for CTO over the last decade. Some studies have suggested improved outcomes with successful CTO PCI.

Methods: Data were analysed from the Melbourne Interventional Group registry from 7,427 patients with stable coronary disease presenting for single-vessel PCI between 2005 and 2017. Multivariate Cox proportional hazards analysis was performed to determine predictors of CTO PCI clinical outcomes, including National Death Index (NDI)-linked mortality using a successful non-CTO PCI comparator population.

Results: Chronic total occlusion PCI was performed for 514 patients (7% of the stable coronary disease cohort) over the study period. Procedural success was achieved for 59% of cases, with no improvement of success rates over time (p = 0.56). Successful CTO PCI postprocedural major adverse cardiac and cerebrovascular event (MACCE) rates were comparable to successful non-CTO PCI. Where CTO PCI was unsuccessful, patients experienced increased in-hospital complications, including increased coronary perforation, major bleeding, unplanned inpatient coronary artery bypass graft, along with higher 30-day and 12-month MACCE rates (all p < 0.05). Despite this, unsuccessful CTO PCI had similar NDI-linked mortality rates when compared to successful CTO and non-CTO PCI, with a mean follow-up of 5.3 ± 3.6 years. Compared to successful non-CTO, unsuccessful non-CTO PCI had increased long-term mortality with an adjusted hazards ratio of 1.52 (95% CI 1.09–2.11, p = 0.01).

Conclusion: Unsuccessful CTO PCI was associated with higher 30-day and 12-month MACCE, but long-term mortality was similar to patients with successful CTO PCI.