Outcomes of chronic total occlusion percutaneous coronary intervention in patients ineligible for surgical revascularization.

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.