Procedural Outcome of Modern Percutaneous Coronary Intervention in Proximal Chronic Total Occlusions

ABSTRACT Background Long‐term outcome in patients with chronic total occlusions (CTO) depends on the target vessel and proximity of the lesion. Aims To investigate of the target vessel was associated with procedural efficacy and safety in patients with proximal CTO lesions. Methods Patients treated for a CTO lesion in the European CTO registry (ERCTO) between January 1, 2021, and December 31, 2023, were included in the study. Patients were categorized based on the treated vessel and the proximity of the lesion. The outcome was compared between proximal lesions in the three native vessels. The co‐primary endpoints were procedural success and 30‐day safety. Procedural success was defined as technical success without in‐hospital major adverse cardiac events. Results A total of 14,744 patients were screened, and 7128 were included in the analysis of proximal CTO PCI. Technical success rates proximal in the three native vessel territories were 91.0% (left anterior descending LAD), 92.1% (left circumflex LCX), and 88.5% (right coronary artery RCA). In the adjusted analysis, the probability of procedural success was higher for LCX compared to RCA, but not for the LAD (OR (95% CI): LCX: 1.35, (1.05−1.75); LAD: 1.06 0.86–1.31). The adjusted 30‐day safety was better in the LAD, but not LCX, compared with RCA (LAD: OR 0.69, 95% CI: 0.50; 0.94, LCX: OR 0.77, 95% CI 0.54; 1.09). Conclusions Modern CTO PCI for proximal lesions generally yields a very high success rate. The procedure tends to be more successful in the LAD and LCX territories compared to the RCA, with LAD lesion treatment being the safest option.