Alp Aytekin, Felix Voll, Fiorenzo Simonetti, Edna Blum, Moritz Kühlein, Konstantin Kuna, Tobias Lenz, Fabian Starnecker, Moritz von Scheidt, Christian Gräßer, Tobias Koch, Masaru Seguchi, Yousuke Taniguchi, Susanne Pinieck, Costanza Pellegrini, Tobias Rheude, Héctor Alfonso Alvarez Covarrubias, Sebastian Kufner, Thorsten Kessler, Hendrik B. Sager, Gjin Ndrepepa, Heribert Schunkert, Michael Joner, Adnan Kastrati, Salvatore Cassese, Erion Xhepa
Background Clinical and angiographic outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remain incompletely investigated, whereas direct comparisons with non-CTO-PCI are missing. The present study aimed to compare the mid-term clinical and angiographic outcomes following successful CTO-PCI and non-CTO-PCI. Methods Consecutive patients from the Intracoronary Stenting and Angiographic Results – Chronic Total Occlusion (ISAR-CTO) Registry undergoing successful CTO recanalization as well as all successful non-CTO-PCI procedures from our institutional database were included. Propensity score matching (PSM) with a 1:3 matching ratio was performed. The primary endpoint was the incidence of major adverse cardiac events (MACE) at 12-month follow-up. The secondary angiographic endpoint was in-segment binary restenosis at surveillance angiography. Results Overall, 453 CTO-PCI patients (472 lesions) and 14733 non-CTO-PCI patients (23458 lesions) were analyzed. After PSM, a total of 1812 patients were included in the present study [CTO-PCI, n=453 patients (472 lesions); non-CTO-PCI, n=1359 patients (1424 lesions)]. There were no significant differences in terms of MACE (adjusted hazard ratio [HR adj ]=1.26, 95% confidence interval [CI] 0.95-1.66) between CTO-PCI and non-CTO-PCI at 12-month follow-up. CTO-PCI independently correlated with a higher risk of target lesion revascularization (TLR) (HR adj =1.66, 95%CI [1.21-2.27]) and a significantly lower risk of MI (HR adj =0.231; 95%CI [0.06-0.98]). CTO-PCI independently correlated with the occurrence of binary restenosis (adjusted odds ratio [OR adj ]=1.86, 95%CI [1.38-2.51]) at surveillance angiography. Conclusions CTO-PCI was independently associated with significantly higher rates of TLR as well as a significantly lower incidence of MI at 12-months follow-up. QCA analysis of surveillance angiography showed superior angiographic outcomes following non-CTO-PCI.