Incidence and in-hospital outcomes of single-vessel coronary chronic total occlusion treated with percutaneous coronary intervention

Int J Cardiol. 2018 Oct 15;269:61-66. doi: 10.1016/j.ijcard.2018.07.075. Epub 2018 Jul 19.


Background: Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of peri-procedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD).

Methods: The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure.

Results: A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008 to 2014. An increasing number of coronary CTO-PCI hospitalizations (2465 to 2688 per 100,000 PCI procedures, Ptrend < 0.001) with an overall in-hospital mortality of 0.5% was observed. The rate of in-hospital mortality remained unchanged (Ptrend = 0.13), but an increasing rate of acute renal failure was observed in the multivariate-adjusted analysis (Ptrend < 0.001). Furthermore, a rise in the utilization of intra-aortic balloon pumps and percutaneous left ventricular assist devices during single-vessel coronary CTO-PCI was noted. Taken together, these may account for increasing costs of hospitalization for single-vessel coronary CTO-PCI ($13,909 in 2008 to $17,729 in 2014, Ptrend < 0.001).

Conclusion: In a large retrospective study, slightly increased rates of single-vessel coronary CTO-PCI for stable CAD were observed. This is accompanied by a rise in morbidity and growing healthcare costs.

Keywords: Chronic total occlusion; Coronary artery disease; Epidemiology; Percutaneous coronary intervention.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Chronic Disease
  • Cohort Studies
  • Coronary Occlusion / diagnosis
  • Coronary Occlusion / mortality*
  • Coronary Occlusion / surgery*
  • Databases, Factual / trends
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / mortality*
  • Percutaneous Coronary Intervention / trends*
  • Retrospective Studies
  • Treatment Outcome