Key result
CTO PCI was associated with a higher risk of long-term repeat revascularization vs non-CTO PCI (aHR 1.09), but a lower risk of long-term MACE vs high-risk non-CTO PCI (aHR 0.87; 95% CI 0.84-0.90).
Why the study?
CTO PCIs are associated with lower success and higher in-hospital event rates compared with non-CTO PCIs, but their long-term outcomes relative to non-CTO and high-risk non-CTO PCIs remained to be examined.
Does CTO PCI improve long-term outcomes compared to non-CTO PCI and high-risk non-CTO PCI in Medicare beneficiaries with stable angina?
Cohort (n=551,722)
Yes
Does CTO PCI improve long-term outcomes compared to non-CTO PCI and high-risk non-CTO PCI in Medicare beneficiaries with stable angina?
Hazard Ratio: 0.87 (95% CI 0.84–0.9)
In Medicare beneficiaries, CTO PCI carries a higher risk of long-term repeat revascularization than standard non-CTO PCI, but a lower risk of long-term MACE compared to high-risk non-CTO PCI.
May lower long-term MACE vs high-risk non-CTO PCI but raises repeat revascularization risk; leaves open net benefit in stable angina.
Background: Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) represent 4% of all PCIs for stable angina in the United States and have been associated with lower success and higher in-hospital event rates compared with non-CTO PCIs. We aimed to examine long-term outcomes of CTO PCI compared with non-CTO PCI, including prespecified subgroups of high-risk non-CTO PCI (atherectomy/saphenous vein graft/unprotected left main). Methods: Among 551,722 patients in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare (July 2009-December 2016), we evaluated in-hospital events and long-term major adverse cardiovascular events of CTO PCIs (N = 29,407) compared with non-CTO PCIs (N = 522,315). We then evaluated similar outcomes between CTO PCIs and high-risk non-CTO PCIs (N = 53,662). We excluded patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. Results: = .008). In addition, CTO PCI was associated with a slightly higher risk of long-term repeat revascularization compared with non-CTO PCI (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.05-1.13). However, compared with high-risk non-CTO PCIs, CTO PCIs were associated with a slightly lower risk of long-term major adverse cardiovascular events (aHR, 0.87; 95% CI, 0.84-0.90) and readmission (aHR, 0.87; 95% CI, 0.84-0.90). Conclusions: In this study, CTO PCI was associated with higher risk of both in-hospital and out-of-hospital events but a slightly lower risk of long-term events compared with high-risk non-CTO PCIs. These findings shed light on the complexity of various PCI procedures that can inform clinicians and patients of expected outcomes.
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Almarzooq et al. (2023) conducted a cohort in Chronic total occlusion (stable angina) (n=551,722). Chronic total occlusion (CTO) PCI vs. Non-CTO PCI and high-risk non-CTO PCI was evaluated on Long-term major adverse cardiovascular events (compared with high-risk non-CTO PCIs) (aHR 0.87, 95% CI 0.84-0.90). CTO PCI was associated with a higher risk of long-term repeat revascularization vs non-CTO PCI (aHR 1.09), but a lower risk of long-term MACE vs high-risk non-CTO PCI (aHR 0.87; 95% CI 0.84-0.90).
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