Key result
CTO PCI shows similar 30-day mortality to non-CTO PCI but links to higher CABG rates.
Why the study?
PCI for CTO lesions poses greater technical challenges than for non-CTO lesions, and its outcomes in modern practice remain only partially understood.
Does PCI for CTO lesions increase 30-day adverse outcomes compared to non-CTO PCI in adult patients?
Cohort
Yes
Does PCI for CTO lesions increase 30-day adverse outcomes compared to non-CTO PCI in adult patients?
Absolute Event Rate: 0.72% vs 0.71%
Over a decade of modern practice, CTO PCI is associated with similar 30-day mortality and ischemic stroke rates compared to non-CTO PCI, despite a slightly higher risk of CABG and pericardiocentesis.
CTO PCI outcomes in contemporary practice remain incompletely characterized; this analysis leaves open whether temporal trends improve risk-benefit versus non-CTO PCI.
Background Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions involves greater technical challenges than PCI for non-CTO lesions. Its outcomes in modern practice remain only partially understood. We aimed to evaluate temporal trends and 30-day outcomes in patients undergoing CTO PCI. Methods Using the TriNetX research database, adult patients undergoing PCI for CTO versus non-CTO lesions between January 2014 and November 2025 were propensity score-matched within predefined time frames (2014-2017, 2018-2021, and 2022-November 2025). Outcomes included 30-day all-cause mortality, ischemic stroke, coronary artery bypass graft (CABG), and pericardiocentesis, with temporal trends assessed among CTO PCI patients. Results After matching, there was no significant difference in 30-day mortality (0.72% vs 0.71%) or ischemic stroke (1.64% vs 1.55%) between CTO PCI and non-CTO PCI. CTO PCI was consistently associated with a higher 30-day incidence of CABG compared with non-CTO PCI across all time frames (2014-2017: hazard ratio [HR], 2.54; 95% CI, 1.57-4.12; 2018-2021: HR, 4.22; 95% CI, 2.18-8.14; 2022-November 2025: HR, 3.13; 95% CI, 1.87-5.25), with absolute rates of 0.91% vs 0.28%, respectively, without a statistically significant temporal trend. Pericardiocentesis occurred more frequently after CTO than non-CTO PCI (0.20% vs 0.09%). Conclusions Over more than a decade, there were no significant differences in mortality or ischemic stroke between CTO PCI and non-CTO PCI. CTO PCI was associated with a higher incidence of pericardiocentesis and CABG, although absolute event rates were low and without an observed impact on 30-day mortality.
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Ramadan et al. (2026) conducted a cohort in Chronic total occlusion (CTO). PCI for CTO lesions vs. PCI for non-CTO lesions was evaluated on 30-day all-cause mortality. PCI for chronic total occlusion showed no significant difference in 30-day mortality (0.72% vs 0.71%) compared to non-CTO PCI, but was associated with a higher incidence of CABG (0.91% vs 0.28%).
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