Kharsa Chloe, Sella Gal, Kritya Mangesh, Sammour Yasser M, Bou Chaaya Rody G, Philip Jerrin, Maqsood Muhammad Haisum, Zoghbi William A, Kleiman Neal S, Shah Alpesh R
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, United States of America.
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, United States of America.
Cardiovasc Revasc Med. 2025 Aug 27. doi: 10.1016/j.carrev.2025.08.014.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world data from the Houston Methodist CTO PCI Registry to characterize procedural success, safety, and mid- to long-term outcomes.
We retrospectively analyzed 507 patients undergoing CTO PCI between 2018 and 2023. Baseline clinical characteristics, procedural details, and outcomes including procedural success, in-hospital complications, and follow-up events were evaluated. Multivariable logistic regression identified predictors of procedural success.
The cohort had a mean age of 65.3 ± 10.0 years, 20.9 % women, and a high prevalence of comorbidities (hypertension 96.1 %, diabetes 49.7 %). The mean J-CTO score was 1.8 ± 1.1. Procedural success was achieved in 81.2 % of cases, with low in-hospital mortality (0.4 %) and complication rates. Annual success rates improved from 72.7 % in 2018 to a peak of 86.7 % in 2020, reflecting growing operator experience and evolving techniques. Multivariable analysis showed that age (OR 0.97, 95 % CI [0.95-1.00]; p = 0.03), cumulative air kerma (OR 1.00, 95 % CI [1.00-1.00]; p = 0.003) and lesion length (OR 1.05, 95 % CI [1.03-1.07], p < 0.001) were independent predictors of success. KM analysis revealed a 2-year overall survival of 91.4 %, freedom from clinically driven target lesion revascularization (TLR) of 93.6 % at 2 years, and event-free survival from target lesion failure (TLF) of approximately 85 % at 2 years. At a median follow-up of 745 days, all-cause mortality was 9.2 %, and TLR occurred in 2.4 % of patients.
CTO PCI can be performed safely with high success rates and favorable mid- to long-term outcomes in a complex population. Procedural success is primarily driven by lesion-specific factors rather than clinical comorbidities. These findings support the continued evolution and application of CTO PCI in appropriately selected patients.
慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）在技术上仍然具有挑战性，关于手术成功的预测因素和长期预后存在持续的争论。我们报告了休斯顿卫理公会CTO PCI注册研究的真实世界数据，以描述手术成功率、安全性以及中长期预后。
我们回顾性分析了2018年至2023年间接受CTO PCI的507例患者。评估了基线临床特征、手术细节以及包括手术成功率、院内并发症和随访事件在内的预后情况。多变量逻辑回归确定了手术成功的预测因素。
该队列的平均年龄为65.3±10.0岁，女性占20.9%，合并症患病率高（高血压96.1%，糖尿病49.7%）。平均J-CTO评分为1.8±1.1。81.2%的病例手术成功，院内死亡率低（0.4%），并发症发生率也低。年成功率从2018年的72.7%提高到2020年的峰值86.7%，反映了术者经验的增加和技术的不断发展。多变量分析显示，年龄（OR 0.97，95%CI[0.95-1.00]；p=0.03）、累积空气比释动能（OR 1.00，95%CI[1.00-1.00]；p=0.003）和病变长度（OR 1.05，95%CI[1.03-1.07]，p<0.001）是成功的独立预测因素。Kaplan-Meier分析显示，2年总生存率为91.4%，2年时免于临床驱动的靶病变血运重建（TLR）率为93.6%，2年时靶病变失败（TLF）的无事件生存率约为85%。在中位随访745天时，全因死亡率为9.2%，2.4%的患者发生了TLR。
在复杂人群中，CTO PCI可以安全地进行，成功率高，中长期预后良好。手术成功主要由病变特异性因素驱动，而非临床合并症。这些发现支持CTO PCI在适当选择的患者中持续发展和应用。
