Mid-Term Efficacy and Safety of Mechanical Circulatory Support in High-Risk Elective Chronic Total Occlusion Percutaneous Coronary Intervention: A Prospective Propensity-Matched Cohort Study.

BACKGROUND AND AIMS: The present study aimed to evaluate the early and 1-year outcomes of using percutaneous mechanical circulatory support (MCS) devices in patients undergoing high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We conducted a prospective registry cohort study that enrolled patients undergoing high-risk elective CTO-PCI with MCS device support and patients without MCS device support. The primary endpoint was major adverse cardiac events (MACE) at 1-year follow-up.

RESULTS

A total of 2349 patients were enrolled, comprising 151 in the MCS group and 2198 in the non-MCS group. Compared with the non-MCS group, the MCS group exhibited a lower left ventricular ejection fraction (LVEF) (41.6 ± 10.4% vs. 50.4 ± 8.0%, p < 0.001) and a higher prevalence of two-vessel CTO (30.5% vs. 18.7%, p < 0.001) and three-vessel CTO (5.3% vs. 1.4%, p < 0.001). After propensity score matching (PSM), 137 patients in each group with comparable propensity scores were included for analysis. The cohort had a mean age of 65.97 ± 10.00 years, with 83.94% male participants. The most common MCS devices were IABP alone (66.42%), followed by ECMO + IABP (26.28%) and ECMO alone (7.30%). The MCS group demonstrated significantly higher technical success rates than the non-MCS group (95.62% vs. 87.59%, p = 0.027) but comparable procedural success rates (86.13% vs. 83.94%, p = 0.611). Complete revascularization rates were significantly higher in the MCS group (89.05% vs. 66.42%, p < 0.001). No differences occurred in 1-year MACE incidence or its components between groups, and MCS device use showed no correlation with 1-year MACE risk.

CONCLUSIONS

MCS-supported CTO-PCI improves technical success rates and complete revascularization achievement rates during the index procedure. However, MCS is associated with a significantly higher incidence of in-hospital MACE and device-related complications, despite showing no significant difference in 1-year MACE rates compared to conventional CTO-PCI.