Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved in recent years. Methods: We compared the clinical, angiographic, and technical characteristics and procedural outcomes of CTO PCI in a multicenter registry between the “early era” (2012 to 2016, 1,986 CTO PCIs) and the “current era” (2017 to 2019, 1,675 CTO PCIs). Results: As compared with “early era” patients, “current era” patients more often had class III or IV angina (71% vs. 66%; p = 0.029) and were less likely to undergo ad hoc CTO PCI (13% vs. 16%; p = 0.035). The J-CTO score was slightly higher in the “early era” (2.3 ± 1.4 vs. 2.5 ± 1.3; p = 0.035). Use of antegrade wire escalation was higher in the current era (92% vs. 83%; p \u3c 0.001), whereas use of retrograde crossing (29% vs. 39%; p \u3c 0.001) and antegrade/dissection re-entry (23% vs. 32%; p \u3c 0.001) was lower. Technical (85% vs. 86%, p = 0.687) and procedural (83% vs. 85%, p = 0.151) success rates were similar, whereas the incidence of in-hospital major cardiovascular events (MACE) was lower in the “current era” (2% vs. 3%; p = 0.037) (Figure). Procedure time (105 min [67, 164 min] vs. 136 min [91, 203 min]; p \u3c 0.001), contrast volume (225 ml [164, 300 ml] vs. 280 ml [200, 370 ml]; p \u3c 0.001), and air kerma radiation dose (2.4 Gy [1.3, 4.1 Gy] vs. 2.8 Gy [1.7, 4.5 Gy]; p \u3c 0.001) were lower during the “current era” (Figure). [Figure presented] Conclusion: During recent years, the complexity of CTO PCI attempted lesions decreased and ad hoc CTO PCI decreased, along with lower use of retrograde crossing and antegrade dissection and re-entry. Technical and procedural success rates remained stable, whereas the incidence of in-hospital MACE decreased. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP