Outcomes of Percutaneous Coronary Intervention in Chronic Total Occlusion among Women
Keywords:
Chronic total occlusion, Percutaneous coronary intervention, Myocardial infarctionAbstract
Objective: To determine the outcomes in female patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion.
Methodology: This longitudinal descriptive study was conducted at the Department of Cardiology, Fauji Foundation Hospital, Rawalpindi from July 2024 to March 2025 after taking approval from the ethical committee. A total of 56 female patients with a diagnosed chronic total occlusion (CTO) who had persistent angina symptoms despite optimal medical therapy were included using non-probability convenience sampling. All these patients were eligible to undergo CTO-PCI with normal kidney function and gave informed consent. The patients underwent CTO-PCI by interventional cardiologists. All the patients had a monthly follow-up for 3 months post-procedure. The outcomes assessed were rate of procedural success, in-hospital major adverse cardiovascular events (MACE) and cardiac mortality & symptom-free at 3 months. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.
Results: The procedural success rate was found in 37(66.1%) patients. In-hospital MACE occurred in 5(8.9%) patients. Two (3.6%) patients died whereas, 40(71.4%) patients were symptom-free at 3 months. In-hospital MACE was significantly less in the successful CTO-PCI group (p-value=0.04) and the majority [34(94.4%)] of the patients in the successful CTO-PCI group were symptom-free at 3 months (p-value=0.001). However, there was no significant difference in mortality at 3 months between the two groups with a p-value of 0.53. The procedural failure was significantly associated with the elderly age group >60 years (p-value=0.02) and diabetes mellitus (p-value=0.004).
Conclusion: The CTO-PCI has a procedural success rate of 66.1% and the majority of the patients were symptom-free after the procedure. The statistically significant outcomes were reduction in the frequency of in-hospital MACE and symptom-free at 3 months in the successful CTO-PCI group. The procedural failure was significantly associated with the elderly age group and diabetes mellitus.
References
1. Vescovo GM, Zivelonghi C, Scott B, Agostoni P. Percutaneous coronary intervention for chronic total occlusion. US Cardiol. 2020; 14:e11. doi:10.15420/ usc.2020.10.
2. Niizeki T, Tsuchikane E, Konta T, Kishi K, Okada H, Ito Y, et al. New angiographic difficulty score for first-attempt chronic total occlusion in the 3 major coronary arteries. JACC Cardiovasc Interv. 2023; 16(20):2542-51. doi:10. 1016/j.jcin.2023.08.046.
3. Xenogiannis I, Pavlidis AN, Karamasis GV. Contemporary percutaneous interventions for coronary chronic total occlusions. Front Cardiovasc Med. 2024; 11:1495936. doi:10.3389/fcvm.2024.1495936.
4. Cilia L, Megaly M, Davies R, Tehrani BN, Batchelor WB, Truesdell AG. A non-interventional cardiologist’s guide to coronary chronic total occlusions. Front Cardiovasc Med. 2024; 11:1350549. doi:10.3389/fcvm.2024.1350549.
5. Karacsonyi J, Vemmou E, Nikolakopoulos ID, Ungi I, Rangan BV, Brilakis ES. Complications of chronic total occlusion percutaneous coronary intervention. Neth Heart J. 2021; 29(1):60-7. doi:10.1007/s12471-020-01502-1.
6. Etriby KAE, Okasha NK, Zahran ME, Mohamed TR. Impact of successful antegrade and retrograde CTO-PCI on short-term prognosis. Egypt Heart J. 2024; 76(1):66. doi:10.1186/s43044-024-00501-6.
Zhao S, Chen Y, Wang Q, Zhu B, Wei Z, Wang Z, et al. Benefits of successful percutaneous coronary intervention in chronic total occlusion patients with diabetes. Cardiovasc Diabetol. 2022; 21(1):271. doi:10.1186/s12933-022-01708-0.
7. Jiang Y, Wei ZY, Wu YJ, Dou KF, Yang WX, Yang YJ, et al. The impacts of percutaneous coronary intervention to treat chronic total occlusion of right coronary artery on the 5-year prognosis: a single-centered retrospective study. Int J Cardiol. 2024; 414:132384. doi:10.1016/j.ijcard.2024. 132384.
8. Gilpin TR, Maznyczka A, Anantharam B, Dana A. Procedural results and long-term outcome of chronic total occlusion percutaneous coronary intervention in a UK non-surgical centre. Interv Cardiol. 2024; 19:e05. doi:10.15420/ icr.2023.23.
9. Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Gorgulu S, Alaswad K, et al. Periprocedural mortality in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry. Circ Cardiovasc Interv. 2023; 16(6):e012977. doi:10.1161/CIRCINTERVENTIONS.123.012977.
10. Munirwan H, Kusyanto FA, Zanisa Z, Latief MH. Chronic total occlusion percutaneous coronary intervention (CTO-PCI) in an intractable heart failure patient: Is there any benefit? Narra J. 2023 Aug; 3(2):e140. doi:10.52225/narrav3i2.140.
11. Synetos A, Koliastasis L, Ktenopoulos N, Katsaros O. Recent advances in coronary chronic total occlusions. J Clin Med. 2025; 14(5):1535. doi:10.3390/jcm14051535.
12. Suleman M, Arif N, Khan MI, Jibran MS, Jamil M, Khan SU, et al. The outcomes and complications of percutaneous interventions in chronic total coronary occlusion. Egypt Heart J. 2024; 76(1):62. doi:10.1186/s43044-024-00490-6.
13. Macherey-Meyer S, Salem K, Heyne S, Meertens MM, Finke K, Mauri V, et al. Percutaneous coronary intervention versus optimal medical therapy in patients with chronic total occlusion: a meta-analysis. J Clin Med. 2024; 13(10):2919. doi:10.3390/jcm13102919.
14. Farag M, Egred M. CTO in contemporary PCI. Curr Cardiol Rev. 2022; 18(1):e310521193720. doi:10.2174/1573403X17666210531143519.
15. Abdelaziz A, Elsayed H, Atta K, Mechi A, Kadhim H, Aboutaleb AM, et al. Short- and long-term outcomes of percutaneous coronary interventions in chronic and non-chronic total occlusions: a meta-analysis of 690,123 patients. Curr Probl Cardiol. 2023; 48(11):101890. doi:10.1016/j.cpcardiol.2023.101890.
16. Almarzooq ZI, Tamez H, Wang Y, Curtis JP, Kirtane AJ, Secemsky EA, et al. Long-term outcomes of chronic total occlusion percutaneous coronary intervention among medicare beneficiaries. J Soc Cardiovasc Angiogr Interv. 2023; 2(2):100584. doi:10.1016/j.jscai.2023.100584.
17. Guan C, Yang W, Song L, Chen J, Qian J, Wu F, et al. Association of acute procedural results with long-term outcomes after CTO-PCI. JACC Cardiovasc Interv. 2021; 14(3):278-88. doi:10.1016/j.jcin.2020.10.003.
18. Vemuri KS, Sihag BK, Sharma Y, Nevali KP, Vijayvergiya R, Kumar RM, et al. Real world perspective of coronary chronic total occlusion in third world countries: a tertiary care centre study from northern India. Indian Heart J. 2021; 73(2):156-60. doi:10.1016/j.ihj.2021.03.001.
19. Khanra D, Mishra V, Jain B, Soni S, Bahurupi Y, Duggal B, et al. Percutaneous coronary intervention provided better long term results than optimal medical therapy alone in patients with chronic total occlusion: a meta-analysis. Indian Heart J. 2020; 72(4):225-31. doi:10.1016/j.ihj.2020.07.013.
20. Zhang D, Nan N, Xue Y, Zhang M, Tian J, Chen C, et al. Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: a systematic review and meta-analysis. Cardiol J. 2024; 31(1):15-23. doi:10.5603/CJ.a2022.0010.
21. Megaly M, Khalil M, Basir MB, McEntegart MB, Spratt JC, Yamane M, et al. Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention. Cardiovasc Interv Ther. 2022; 37(3):483-9. doi:10.1007/s12928-021-00819-x.
22. Rempakos T, Mutlu D, Alexandrou M, Carvalho PEP, Strepkos D, Choi JW, et al. Outcomes of chronic total occlusion percutaneous coronary intervention in young patients. JSCAI. 2024; 3(5):101751. doi:10.1016/j.jscai.2024.101751.
23. Lateef N, Ahsan MJ, Fazeel HM, Haseeb A, Latif A, Kousa O, et al. Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review. J Community Hosp Intern Med Perspect. 2020; 10(1):25-31. doi:10.1080/20009666.2020.1719731.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Journal of Sharif Medical & Dental College is licensed and distributed under the terms of Creative Commons Attribution-NonCommercial 4.0 International License.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
