Impact of CTO-related myocardial infarction and procedural success on long-term outcomes after CTO PCI

Background: The prognostic impact of CTO-related myocardial infarction (MI) and procedural success on long-term outcomes after chronic total occlusion (CTO) PCI remains uncertain. This study evaluated clinical and procedural predictors of adverse outcomes following CTO PCI. Methods: In this retrospective registry, 347 patients who underwent CTO PCI were analyzed after screening 543 individuals between 2004 and 2018-CTO-related MI and procedural success stratified patients. The primary composite endpoint included ventricular tachyarrhythmia and follow-up MACCE, defined as cardiopulmonary resuscitation, coronary artery bypass grafting, pacemaker or implantable cardioverter-defibrillator implantation, acute coronary syndrome, cardiovascular death, or all-cause death. Kaplan-Meier analysis and bootstrap-derived Cox models were used to assess long-term risk. Results: CTO-related MI was associated with a higher cumulative incidence of adverse outcomes, whereas procedural success was associated with improved event-free survival. In multivariable analysis, chronic kidney disease was the strongest independent predictor of the composite endpoint, while higher left ventricular ejection fraction was protective. Procedural success showed a trend toward lower risk, whereas CTO-related MI showed a trend toward higher risk in multivariable analysis. Conclusions: CTO-related MI and unsuccessful CTO PCI were associated with worse long-term outcomes. Chronic kidney disease was the dominant independent predictor, whereas preserved ventricular function was protective. These findings highlight the prognostic value of integrating clinical risk factors and procedural success to refine long-term management strategies after CTO PCI.