Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry

Background. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved in recent years. Methods. We compared the clinical, angiographic, and technical characteristics, as well as procedural outcomes of CTO-PCIs in a multicenter registry between the "early era" (2012-2016) and the "current era" (2017-2019). Results. Current era patients more often had stage III or IV angina compared with early era patients (71% vs 66%, respectively: P=.03] and were less likely to undergo ad hoc CTO-PCI (13% vs 16%, respectively; P=.04). The J-CTO score was slightly lower in the current era patients vs the early era patients (2.3 +/- 1.4 vs 2.5 +/- 1.3, respectively; P=.04). Use of antegrade wire escalation increased in the current era (92% vs 83% in the early era patients; P<.001) whereas use of retrograde crossing decreased [29% vs 39% in the early era; P<.001) and antegrade/ dissection re-entry decreased [23% vs 32% in the early era: P<.001). Technical success rates [85% in the current era vs 86% in the early era; P=.69) and procedural success rates (83% in the current era vs 85% in the early era; P=.15) were similar, whereas the incidence of in-hospital major cardiovascular events decreased in the current era (2% vs 3% in the early era; P=.04). Conclusions. During recent years, ad hoc CTO-PCI decreased along with decreasing use of retrograde crossing and antegrade dissection and re-entry. Technical and procedural success rates remained stable, whereas the incidence of in-hospital MACE decreased.