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

Objective: To assess hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO). Background: There are limited data regarding long-term HMACE risks based on PCI-CTO success. Methods: First-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. Results: 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. Conclusions: The 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.