Long-term clinical outcomes after successful and failed recanalization to native chronic Total occlusion: Insights from the Busan chronic Total occlusion (B-CTO) Registry

• The hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO) are uncertain.
• There are limited data regarding long-term HMACE risks dependent on PCI-CTO outcomes.
• We analyzed first-time PCI in 438 consecutive patients with 473 target CTO lesions. Patients after procedural success (n = 355; 378 CTO lesions) and failure (n = 83; 95 CTO lesions) were followed for an average 40 months (7-77 months range).
• We compared HMACE (composite of cardiac death, non-fatal myocardial infarction (MI), and stroke) dependent on the outcomes of PCI-CTO.
• The incidence of HMACE was low, with a total of 16 events, and did not differ {6% vs.3.1%, HR = 0.47; CI [0.16-1.35; p = 0.162} dependent on the success of PCI-CTO. There were less cardiac deaths {0.3% vs. 1.2%, RR = 0.22; CI [0.01-3.50];p = 0.283}, non fatal MI {1.1% vs.3.6%, RR = 0.27; CI [0.06-1.22], p = 0.089}, but more strokes {1.7% vs.1.2%, RR = 1.32; CI [0.16-10.99], p = 0.795} after successful PCI-CTO.
• The risks of HMACE after PCI-CTO over long-term follow-up were minimal, and do not depend on the procedure success.
• This surprise finding somewhat challenge the aggressive interventional approach, and should be confirmed in the adequately powered randomized trial.
• Obviously, yet unclear, compensatory mechanism to protect from failed CTO recanalization should be considered, and explored further.

ObjectiveTo assess hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO).BackgroundThere are limited data regarding long-term HMACE risks based on PCI-CTO success.MethodsFirst-time PCI was performed in 438 consecutive patients with 473 target CTO lesions. Patients after procedural success (n = 355; 378 CTO lesions) and failure (n = 83; 95 CTO lesions) were followed for an average 40 months (7–77 months range). We compared HMACE (composite of cardiac death, non-fatal myocardial infarction (MI), and stroke) dependent on the success of PCI.ResultsThe incidence of HMACE was low, with a total of 16 events, and did not differ {6% vs.3.1%, HR = 0.47; CI [0.16–1.35; p = 0.162} dependent on the success of PCI-CTO. There were less cardiac deaths {0.3% vs. 1.2%, RR = 0.22; CI [0.01–3.50];p = 0.283}, non fatal MI {1.1% vs.3.6%, RR = 0.27; CI [0.06–1.22], p = 0.089}, but more strokes {1.7% vs.1.2%, RR = 1.32; CI [0.16–10.99], p = 0.795} after successful PCI-CTO.ConclusionsThe risks of HMACE after PCI-CTO over long-term follow-up were minimal, and do not depend on the procedure success. This unexpected finding somewhat challenge the aggressive interventional approach, and should be confirmed in the adequately powered randomized trial.