Percutaneous coronary intervention of patients with chronic total occlusion is associated with higher mortality and complications despite propensity score matching

BackgroundThe rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is increasing, yet its clinical value remains controversial. CTO-PCI is associated with high procedural risk, such as perforation and tamponade. The goal of this study was to compare complications and mortality of patients undergoing CTO-PCI with patients without CTO undergoing PCI (non-CTO-PCI) by using propensity score matching. MethodsThe national Inpatient Sample database (NIS), years 2016-2020, was studied using International Classification of Diseases, Tenth Revision Codes. Propensity Score Matching was used to compare patients with CTO-PCI with patients non-CTO-PCI. ResultsAmong 519,620 PCI hospitalizations, 259,810 had CTO-PCI. After matching, CTO-PCI had higher mortality (OR 1.13; 95% CI 1.05-1.22; p=0.001) and higher odds of myocardial infarction (OR 1.97; 1.64-2.38), perforation (OR 3.36; 2.63-4.28), tamponade (OR 2.07; 1.63- 2.65), bleeding (OR 1.88; 1.64-2.15), and respiratory failure (OR 1.80; 1.45-2.24); all p<0.001. Overall risk doubled for any complication (OR 2.04; 1.85-2.25) and rose to 42% for MACE (OR 1.42; 1.34-1.51). When perforation or tamponade occurred, mortality was striking much higher in CTO-PCI compared to non-CTO-PCI (2.43% vs 0.55% and 22.86% vs 1.17%; both p<0.001). ConclusionsPropensity-matched national cohort confirmed that CTO-PCI was associated with higher in-hospital complications and mortality compared to non-CTO-PCI, mostly driven by perforation and tamponade. These findings support the previous report that CTO-PCI is associated with worse outcomes.