Lesion Complexity and Procedural Outcomes Associated With Ostial Chronic Total Occlusions: Insights From the PROGRESS-CTO Registry

Objectives. Ostial CTOs can be challenging to revascularize. We aim to describe the outcomes of ostial chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods. We examined the clinical and angiographic characteristics and procedural outcomes of 8788 CTO PCIs performed at 35 US and non -US centers between 2012 and 2022. In -hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. Results. Ostial CTOs constituted 12% of all CTOs. Patients with ostial CTOs had higher J-CTO score (2.9 +/- 1.2 vs 2.3 +/- 1.3; P<.01). Ostial CTO PCI had lower technical (82% vs. 86%; P<.01) and procedural (81% vs. 85%; P<.01) success rates compared with non-ostial CTO PCI. Ostial location was not independently associated with technical success (OR 1.03, CI 95% 0.83-1.29 P =.73). Ostial CTO PCI had a trend towards higher incidence of MACE (2.6% vs. 1.8%; P =.06), driven by higher incidence of inhospital death (0.9% vs 0.3% P<.01) and stroke (0.5% vs 0.1% P <.01). Ostial lesions required more often use of the retrograde approach (30% vs 9%; P<.01). Ostial CTO PCI required longer procedure time (149 [103,204] vs 110 [72,160] min; P<.01) and higher air kerma radiation dose (2.3 [1.3, 3.6] vs 2.0 [1.1, 3.5] Gray; P<.01). Conclusions. Ostial CTOs are associated with higher lesion complexity and lower technical and procedural success rates. CTO PCI of ostial lesions is associated with frequent need for retrograde crossing, higher incidence of death and stroke, longer procedure time and higher radiation dose.