Strong Bias Toward Performing Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion Despite Lack of Important Benefit at a Very High Cost and Risk to the Patient

Movahed, Mohammad Reza

doi:10.1016/j.jcin.2018.04.031

Cited by 2 publications

(2 citation statements)

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“…While CTO-PCI may be appropriate in cases of severe, refractory angina, its current use is rarely limited to such severe cases. 25 For example, in the previously discussed study by Xenogiannis et al, less than 50% of the patients were on nitrate or calcium channel blockers. 23 Additionally, a previous study using NIS data from the years 2008-2014 identified 109,094 patients with CTO who underwent PCI.…”

Section: Discussionmentioning

confidence: 93%

“…Any of the adverse events observed in the unsuccessful arm would not have occurred had the patients been given OMT, as was the case in the previously discussed randomized trials. Additionally, such studies often neglect to emphasize the role of baseline patient characteristics (often poorer in the failed CTO PCI group), which was the case in the study conducted by Xenogiannis et al 25 Thus, comparing successful and failed CTO-PCI is a flawed means of assessing the efficacy and safety of PCI for CTO, and results from such studies should not be considered when developing guidelines for the use of PCI for CTO.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Coronary Intervention of Chronic Total Occlusion is Associated with Higher Inpatient Mortality and Complications Compared to Non-CTO lesions Using the National Inpatient Sample (NIS) Database

Nathan

Hashemzadeh

Movahed

2023

Preprint

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Background: Percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the post-procedural outcome of patients with CTO intervention. Methods: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients with CTO intervention were compared to patients without CTO. We evaluated post-procedural mortality and complications. Results: PCI in patients with CTO was associated with higher mortality and all post-procedural complications. A total of 2,011,854 patients underwent PCI with 259,574 having CTO. The CTO group had a 3.17% mortality rate vs 2.57% of non-CTO PCI. (OR, 1.24; CI:1.18 – 1.31; p<0.001). Using multivariate analysis adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, CTO PCI remained significantly associated with higher mortality (OR, 1.37; 95% CI, 1.3 – 1.45; p<0.001). Patients with CTO compared to non-CTO PCI patients had higher rates of myocardial infarction (OR, 2.85; 95% CI, 2.54 – 3.21; p<0.001), coronary perforation (OR, 6.01; 95% CI, 5.25-6.89; p<0.001), tamponade (OR, 3.36; 95% CI, 2.91-3.88, p<0.001), contrast-induced nephropathy (OR, 2.05; 95% CI, 1.45-2.90), p<0.001), procedural bleeding (OR, 3.57; 95% CI, 3.27-3.89, p<0.001), and acute post-procedural respiratory failure (OR, 2.07; 95% CI, 1.81-2.36, p<0.001). All post-procedural complications were more than 3 times the non-CTO patients (OR, 3.45; 95% CI, 3.24-3.67; p<0.001). Conclusion: Using a large national inpatient database, PCI performed in patients with CTO was associated with significantly much higher mortality and post-procedural complications compared to PCI in non-CTO patients.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%