Procedural Characteristics and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With and Without Prior CABG.

BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) is associated with greater anatomical and procedural complexity. However, whether prior CABG independently influences procedural success remains uncertain. METHODS: We retrospectively analyzed 521 consecutive patients who underwent elective CTO PCI at a tertiary cardiovascular referral center between January 2013 and December 2023. Patients were categorized into post-CABG (n=102) and non-CABG (n=419) groups. Clinical and angiographic characteristics, procedural strategies, technical success, and in-hospital outcomes were compared. Multivariable logistic regression analysis was performed to identify independent predictors of procedural failure. RESULTS: Patients with prior CABG had higher J-CTO scores (median, 2 [IQR, 1-3] vs. 2 [IQR, 1-2]; p<0.001), more frequent use of the retrograde approach (20.6% vs. 11.0%; p=0.015), and longer procedure times (85 vs. 68 minutes; p=0.001). Advanced crossing techniques were also more frequently used in the post-CABG group (31.4% vs. 12.2%; p<0.001). Technical success was achieved in 87.3% of patients with prior CABG and 91.4% of those without prior CABG (p=0.272). Overall procedural complication rates were comparable (2.9% vs. 3.8%; p=0.897), as was in-hospital mortality (2.0% vs. 1.7%; p=0.691). On multivariable analysis, J-CTO score (OR, 2.52; 95% CI, 1.62-3.93; p<0.001) and age (OR, 1.04 per year; 95% CI, 1.01-1.08; p=0.008) independently predicted procedural failure, whereas prior CABG did not (OR, 1.12; 95% CI, 0.53-2.36; p=0.760). CONCLUSIONS: Prior CABG is associated with greater CTO lesion complexity, more frequent use of retrograde techniques, and longer procedure times but does not independently compromise technical success or in-hospital outcomes. Lesion complexity, as quantified by the J-CTO score, and age appear to be the principal determinants of procedural failure.