D-36 | Chronic Lung Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

The relationship between chronic lung disease and in-hospital outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We examined 12,965 CTO PCIs (12,951 patients) that were performed at 48 US and non-US centers between 2012 and 2023 in the PROGRESS CTO registry. During the study period, 1,825 (14.1%) patients undergoing CTO PCI had chronic lung disease. These patients were older, less likely to be men, and had higher prevalence of diabetes, hypertension, dyslipidemia, prior heart failure, prior coronary artery bypass graft surgery, prior myocardial infarction, cerebrovascular and peripheral arterial disease. They had higher J-CTO (2.53 vs 2.34; p<0.001) and PROGRESS-CTO (1.29 vs 1.23; p=0.016) scores, longer lesion length and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification and proximal tortuosity. Their procedure and fluoroscopy times were longer. Technical (87.1% vs 87.1%; p>0.9) and procedural (85.0% vs 85.9%; p=0.3) success were similar between groups. The incidence of major adverse cardiovascular events (MACE) was higher in patients with chronic lung disease (2.7% vs 1.8%; p=0.011), on univariable (odds ratio [OR] 1.50, 95% CI 1.09 – 2.04, p = 0.011) but not on multivariable analysis (OR 0.83, 95% CI 0.50 – 1.31, p=0.4). Chronic lung disease patients had higher incidence of in-hospital stroke (0.3% vs 0.1%; p=0.018), pericardiocentesis (1.5% vs 0.9%; p=0.017) and perforation (6.6% vs 4.4%; p<0.001). Patients with chronic lung disease undergoing CTO PCI have more comorbidities, more complex CTOs, similar technical success, and higher MACE.