Longitudinal results from a dedicated chronic total coronary occlusions percutaneous coronary intervention program—a single-center experience

OBJECTIVE: To provide insight into the longitudinal (> 10 years) results of a dedicated CTO PCI program in a single center. BACKGROUND: Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) requires substantial operator experience. Dedicated CTO programs aim to increase technical success rates through sufficient case volume. However, longitudinal data beyond 10 years on such programs are scarce. METHODS: We included 1185 patients who underwent CTO PCI in the Amsterdam University Medical Center between 2013 and 2024. Technical CTO PCI success was defined as thrombolysis in myocardial infarction flow grade 3 and < 30% residual stenosis. Procedural success was defined as technical success in the absence of in-hospital major adverse cardiovascular events. Multivariable logistic regression analyses were used to identify predictors for technical success. RESULTS: Mean age was 66 ± 11 years; 81% were male. Overall technical CTO PCI success (92%) and procedural success (87%) rates were high and consistent. We observed temporal changes in wire crossing time (31 [7-56] to 23 [5-67] minutes), contrast volume (360 ± 160 to 210 ± 101 mL), and procedural time (90 [60-130] to 121 [80-165] minutes). Additionally, MACE rate improved from 13% (in 2013-2015) to 7% (in 2021-2024). Age ≥ 65 years, prior CABG, three-vessel disease, and an intermediate to high J‑CTO score (≥ 2) predicted technical failure. CONCLUSIONS: This study reports the longitudinal (> 10 years) results of a dedicated CTO PCI program, which confirms that high technical CTO PCI and procedural success rates can be achieved by a single center.