TCT-274 Chronic Total Occlusion Specialist Outcomes in Non-CTO Percutaneous Coronary Intervention: Insights From BMC2

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Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries elevated procedural risk given the technical challenges of such procedures. It is unclear whether CTO PCI experience translates to procedural or outcome differences in non-CTO PCI. Methods: We analyzed non-CTO PCI cases from 48 nonfederal hospitals in Michigan from 4/1/2020 to 12/31/2022 to compare cases performed by operators with and without CTO experience. CTO specialists were defined as those who performed at least 30 CTO cases in the 3 years preceding the analysis. Cases were matched 1:1 without replacement based on a propensity score model including patient demographics and baseline risk factors, lesion location, and markers of increased procedural complexity. Results: Of the 367 operators in the analysis, there were 20 (5.5%) who met the criteria for CTO specialization. These operators performed 4,147 (10.4%) of the 39,963 non-CTO PCIs during the study period. CTO specialists were more likely to treat left main lesions (11.1% vs 4.2%; P < 0.001) and patients with a history of heart failure (46.1% vs 37.1%; P < 0.001). After matching, no statistically or clinically significant baselines differences remained. CTO specialists in the matched cohort were more likely to use intravascular imaging for PCI optimization (39.5% vs 31.4%; P < 0.001) and had lower contrast use. No significant differences were observed in clinical outcomes, including death, acute kidney injury, and major bleeding. [Formula presented] Conclusion: In a real-world PCI registry, CTO specialists were more likely to treat left main lesions and patients with heart failure. After matching, CTO experience was associated with decreased contrast use and increased use of intravascular imaging for PCI optimization in non-CTO cases. CTO experience was not associated with a difference in adverse events or in-hospital outcomes. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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