Chronic Total Occlusion PCI in Cancer Patients: National Trends and Periprocedural Risk Stratification.

BACKGROUND: Outcomes of chronic total occlusion (CTO) PCI in patients with active malignancy remain poorly characterized. We examined cancer prevalence trends and in-hospital outcomes among cancer patients undergoing CTO PCI nationally. METHODS: We analyzed the National Inpatient Sample (2016-2022), identifying CTO PCI admissions using ICD-10-CM/PCS codes. Survey-weighted multivariable logistic regression and inverse probability of treatment weighting (IPTW) compared outcomes in cancer versus no-cancer patients. Myelosuppression was examined as a prespecified high-risk subgroup. RESULTS: Among 214,365 weighted CTO PCI admissions, 4135 (1.9%) involved active cancer. Although absolute CTO PCI volume declined, the proportion of recipients with active cancer increased over the study period (survey-weighted odds ratio [OR]/year 1.065, 95% confidence interval [CI] 1.028-1.104, p = 0.0007). Despite higher unadjusted mortality (5.2% vs. 3.7%), cancer was not independently associated with higher in-hospital mortality after multivariable adjustment (adjusted OR [aOR] 0.91, 95% CI 0.63-1.32, p = 0.62) or IPTW (aOR 1.14, 95% CI 0.76-1.70, p = 0.54). In an exploratory subgroup, myelosuppression was associated with more than twofold higher mortality (aOR 2.59, 95% CI 1.07-6.29, p = 0.037); though this finding is hypothesis-generating given the small sample (n = 44). CONCLUSIONS: Active malignancy was not independently associated with in-hospital mortality among patients selected for CTO PCI, though findings cannot establish broad procedural safety given the pre-selected cohort. Myelosuppression and elevated transfusion risk represent periprocedural considerations warranting prospective validation.