Incidence and in-hospital outcomes of single-vessel coronary chronic total occlusion treated with percutaneous coronary intervention.

Background: Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of peri-procedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD).

Methods: The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure.

Results: A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008 to 2014. An increasing number of coronary CTO-PCI hospitalizations (2465 to 2688 per 100,000 PCI procedures, P < 0.001) with an overall in-hospital mortality of 0.5% was observed. The rate of in-hospital mortality remained unchanged (P = 0.13), but an increasing rate of acute renal failure was observed in the multivariate-adjusted analysis (P < 0.001). Furthermore, a rise in the utilization of intra-aortic balloon pumps and percutaneous left ventricular assist devices during single-vessel coronary CTO-PCI was noted. Taken together, these may account for increasing costs of hospitalization for single-vessel coronary CTO-PCI ($13,909 in 2008 to $17,729 in 2014, P < 0.001).

Conclusion: In a large retrospective study, slightly increased rates of single-vessel coronary CTO-PCI for stable CAD were observed. This is accompanied by a rise in morbidity and growing healthcare costs.