Percutaneous Coronary Intervention of Chronic Total Occlusion is Associated with Higher Inpatient Mortality and Complications Compared to Non-CTO lesions Using the National Inpatient Sample (NIS) Database

Background Percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the post-procedural outcome of patients with CTO intervention. Methods The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients with CTO intervention were compared to patients without CTO. We evaluated post-procedural mortality and complications. Results PCI in patients with CTO was associated with higher mortality and all post-procedural complications. A total of 2,011,854 patients underwent PCI with 259,574 having CTO. The CTO group had a 3.17% mortality rate vs 2.57% of non-CTO PCI. (OR, 1.24; CI:1.18–1.31; p<0.001). Using multivariate analysis adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, CTO PCI remained significantly associated with higher mortality (OR, 1.37; 95% CI, 1.3 – 1.45; p<0.001). Patients with CTO compared to non-CTO PCI patients had higher rates of myocardial infarction (OR, 2.85; 95% CI, 2.54 – 3.21; p<0.001), coronary perforation (OR, 6.01; 95% CI, 5.25-6.89; p<0.001), tamponade (OR, 3.36; 95% CI, 2.91-3.88, p<0.001), contrast-induced nephropathy (OR, 2.05; 95% CI, 1.45-2.90), p<0.001), procedural bleeding (OR, 3.57; 95% CI, 3.27-3.89, p<0.001), and acute post-procedural respiratory failure (OR, 2.07; 95% CI, 1.81-2.36, p<0.001). All post-procedural complications were more than 3 times the non-CTO patients (OR, 3.45; 95% CI, 3.24-3.67; p<0.001). Conclusion Using a large national inpatient database, PCI performed in patients with CTO was associated with significantly much higher mortality and post-procedural complications compared to PCI in non-CTO patients.