Percutaneous coronary intervention of patients with chronic total occlusion is associated with higher mortality and complications despite propensity score matching
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Background
The 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.
Methods
The 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.
Results
Among 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).
Conclusions
Propensity-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.
