CTO PCI Associated With Higher Risk of In-Hospital and Out-of-Hospital Events, Lower Risk of Long-Term Events vs. High-Risk Non-CTO PCI

Chronic total occlusion (CTO) PCI was associated with a higher risk of adverse events both in-hospital and out-of-hospital, but also with a lower risk of long-term adverse events compared to high-risk non-CTO PCI, according to a recent study published in JSCAI.

Zaid Almarzooq, MBBcH, MPH, FACC, et al., looked at 551,722 Medicare patients captured by ACC’s CathPCI Registry from July 2009 to Dec. 2016, where 29,407 patients underwent CTO PCI and 522,315 non-CTO PCI. Researchers analyzed in-hospital events as well as long-term major adverse cardiovascular events among CTO PCIs and non-CTO PCIs considered high-risk (n=53,662). Patients with STEMI and NSTEMI were excluded.

Results revealed that patients undergoing CTO PCI were more likely to be younger (mean age, 73.7) and male (69.5%), with a higher risk of in-hospital events when compared to both non-CTO PCI (7.0% vs. 4.2%; p<0.001) and high-risk non-CTO PCI (7.0% vs. 6.5%; p=0.008). CTO PCI was additionally associated with a higher risk of long-term repeat revascularization compared with non-CTO PCI (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.05-1.13).

When evaluating high-risk non-CTO PCIs, researchers noted a slightly lower risk with CTO PCI for long-term major adverse cardiovascular events and readmission (aHR, 0.87; 95% CI, 0.84-0.90).

In this first multicenter study to evaluate “long-term follow-up on CTO PCI outcomes compared with high-risk non-CTO PCI,” the study authors acknowledge the lack of a core laboratory to evaluate angiograms, its observational design and inclusion of Medicare beneficiaries only as limitations.

“In this large national cohort of patients undergoing PCI, we found that patients undergoing CTO PCI experienced lower procedural success rates and higher adverse events during the index hospitalization,” Almarzooq, et al., write. “These differences were less evident when comparing CTO PCI with high-risk non-CTO PCI and varied across the subgroups of high-risk non-CTO PCI.”

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Angiography, Registries, Medicare, Patient Readmission, Follow-Up Studies, Percutaneous Coronary Intervention, Non-ST Elevated Myocardial Infarction, ST Elevation Myocardial Infarction, CathPCI Registry, National Cardiovascular Data Registries

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