Procedural and In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction: Insights From a Prospective Multicenter International Registry

J Invasive Cardiol. 2021 Sep;33(9):E670-E676.


Background: We sought to examine the procedural and clinical outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI).

Methods: We assessed the clinical and procedural characteristics, technical success, procedural success, and in-hospital outcomes of 2314 patients who underwent CTO-PCI at 20 experienced centers between 2012 and 2017, classified according to whether or not they presented with AMI.

Results: Mean patient age was 65 ± 10 years, 85% were men, and 154 (6.7%) presented with AMI (5.5% with non-ST segment elevation myocardial infarction, 1.1% with ST-segment elevation myocardial infarction). Compared with non-AMI patients who underwent CTO-PCI, AMI patients had higher prevalence of diabetes (56% vs 42%; P<.01) and lower median left ventricular ejection fraction (48% vs 54%; P<.001). The CTO angiographic characteristics were similar between the 2 groups. Compared with non-AMI patients undergoing CTO-PCI, AMI patients had more frequent use of antegrade wire escalation (86.0% vs 78.9%; P=.03) and more frequent use of hemodynamic support devices (16.2% vs 3.4%; P<.01), and were more likely to have a non-CTO lesion treated (34.0% vs 26.6%; P=.03). AMI and non-AMI patients had similar technical success (90% vs 87%; P=.26), procedural success (88% vs 85%; P=.38), and incidence of in-hospital MACE (2.6% vs 2.5%; P=.94).

Conclusion: CTO-PCI is performed infrequently in AMI patients and is associated with similar technical and procedural success rates and in-hospital major adverse cardiovascular event rates when compared with CTO-PCI performed in non-AMI patients.

Keywords: acute myocardial infarction; chronic total occlusion (CTO); percutaneous coronary intervention.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Chronic Disease
  • Coronary Angiography
  • Coronary Occlusion* / diagnosis
  • Coronary Occlusion* / surgery
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / surgery
  • Percutaneous Coronary Intervention* / adverse effects
  • Prospective Studies
  • Registries
  • Risk Factors
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Function, Left