TCT CONNECT-228 In-hospital Outcomes of CTO PCI in Octogenarians and Nonagenarians: Insights From the PROGRESS-CTO Registry

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Conference Proceeding

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Journal of the American College of Cardiology


Background: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study.

Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 years and <80-years-old in 6,233 CTO PCIs performed in 6,050 patients between 2012 and 2020 at 33 U.S. and international centers.

Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octogenarians and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.09). The most common crossing strategy used was antegrade wire escalation in both groups (84% in octogenarians/nonagenarians vs. 85% in younger patients, p = 0.64).Non-CTOs were treated at the same time in 32% of patients in the ≥80-year-old group compared with 25% in the <80-year-old group (p = 0.018). Octogenarians and nonagenarians were more likely to have balloon uncrossable (17% vs. 10%, p = 0.0006) and balloon undilatable lesions (15% vs. 9%, p = 0.006). The octogenarians/nonagenarians had lower technical and procedural success (82.2% vs. 86.3%, p = 0.02, 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (MACE) (3.4% vs. 1.8%, p = 0.02) (Figure 1). Most in-hospital MACE events were cardiac tamponade requiring pericardiocentesis (Figure 2). [Formula presented] [Formula presented]

Conclusion: CTO-PCI is feasible in octogenarians and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients.





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