International journal of cardiology · 2026
Outcomes of chronic total occlusion percutaneous coronary intervention in patients ineligible for surgical revascularization.
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Park Joseph, Poletti Enrico, Thotakura Sudhir, Kearney Kathleen E, Lombardi William L, Azzalini Lorenzo
Аннотация
BACKGROUND: Patients with chronic total occlusion (CTO) and multivessel coronary artery disease are frequently considered for coronary artery bypass grafting; however, a substantial proportion are deemed ineligible because of comorbidity burden or unfavorable coronary anatomy. Data on surgically ineligible patients undergoing CTO percutaneous coronary intervention (PCI) are limited.
METHODS: We analyzed consecutive patients undergoing CTO PCI at a high-volume referral center between 2019 and 2023. Outcomes in surgically ineligible patients were compared with those of other patients undergoing CTO PCI. The primary outcome was all-cause mortality at 30 days and 1 year. Overlap weighting targeting the average treatment effect in the overlap population was used to adjust for baseline differences.
RESULTS: Among 1135 patients undergoing CTO PCI, 75 (6.6%) were deemed surgically ineligible. Surgically ineligible patients had greater comorbidity, lower left ventricular ejection fraction, higher rates of dialysis, presented more frequently with non-ST elevation myocardial infarction, and had more extensive coronary artery disease. Technical success was similar between groups (94.7% vs 91.1%, p = 0.401). After adjustment, no excess mortality was identified at 30 days (restricted mean survival time [RMST] difference 0.53 days, 30.0 vs. 29.5 days, 95% CI 0.1-1.1) and 1 year (RMST difference 17.7 days, 362.4 vs. 344.8 days, 95% CI 5.0-31.8), although these findings should be interpreted cautiously given the few mortality events.
CONCLUSIONS: Among patients undergoing CTO PCI, surgically ineligible patients demonstrated greater clinical complexity yet achieved similar technical success and similar adjusted outcomes compared with all other CTO PCI patients.
METHODS: We analyzed consecutive patients undergoing CTO PCI at a high-volume referral center between 2019 and 2023. Outcomes in surgically ineligible patients were compared with those of other patients undergoing CTO PCI. The primary outcome was all-cause mortality at 30 days and 1 year. Overlap weighting targeting the average treatment effect in the overlap population was used to adjust for baseline differences.
RESULTS: Among 1135 patients undergoing CTO PCI, 75 (6.6%) were deemed surgically ineligible. Surgically ineligible patients had greater comorbidity, lower left ventricular ejection fraction, higher rates of dialysis, presented more frequently with non-ST elevation myocardial infarction, and had more extensive coronary artery disease. Technical success was similar between groups (94.7% vs 91.1%, p = 0.401). After adjustment, no excess mortality was identified at 30 days (restricted mean survival time [RMST] difference 0.53 days, 30.0 vs. 29.5 days, 95% CI 0.1-1.1) and 1 year (RMST difference 17.7 days, 362.4 vs. 344.8 days, 95% CI 5.0-31.8), although these findings should be interpreted cautiously given the few mortality events.
CONCLUSIONS: Among patients undergoing CTO PCI, surgically ineligible patients demonstrated greater clinical complexity yet achieved similar technical success and similar adjusted outcomes compared with all other CTO PCI patients.