Percutaneous Coronary Intervention of Chronic Total Occlusion Associated with Higher Inpatient Mortality and Complications Compared to Non-CTO lesions.

BACKGROUND: Percutaneous coronary intervention in patients with chronic total occlusion is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the post-procedural outcome of patients with chronic total occlusion intervention.

METHODS: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients with chronic total occlusion interventions were compared to patients without chronic total occlusion. We evaluated post-procedural mortality and complications.

RESULTS: Percutaneous coronary intervention in patients with chronic total occlusion was associated with higher mortality and all post-procedural complications. A weighted total of 10,059,269 patients underwent percutaneous coronary intervention, with 259,574 having chronic total occlusion. The chronic total occlusion group had a 3.17% mortality rate vs 2.57% of non-chronic total occlusion percutaneous coronary interventions. (OR, 1.24; CI:1.18-1.31; p<0.001). Using multivariate analysis adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, chronic total occlusion percutaneous coronary intervention remained significantly associated with higher mortality (OR, 1.07; 95% CI, 1.02- 1.13; p<0.001). Patients with chronic total occlusion compared to non-chronic total occlusion percutaneous coronary intervention had higher rates of myocardial infarction (OR, 2.85; 95% CI, 2.54 - 3.21; p<0.001), coronary perforation (OR, 6.01; 95% CI, 5.25-6.89; p<0.001), tamponade (OR, 3.36; 95% CI, 2.91-3.88, p<0.001), contrast-induced nephropathy (OR, 2.05; 95% CI, 1.45-2.90), p<0.001), procedural bleeding (OR, 3.57; 95% CI, 3.27-3.89, p<0.001), and acute post-procedural respiratory failure (OR, 2.07; 95% CI, 1.81-2.36, p<0.001). All post-procedural complications were more than 3 times the non-chronic total occlusion patients (OR, 3.45; 95% CI, 3.24-3.67; p<0.001).

CONCLUSION: Using a large national inpatient database, percutaneous coronary intervention performed in patients with chronic total occlusion was associated with significantly much higher mortality and post-procedural complications compared to percutaneous coronary intervention in non-chronic total occlusion patients.