Background: In recent years, techniques and material to treat a chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has significantly evolved. Nevertheless, it is still unknown whether the technical progress improved treatment success and the outcome of CTO PCIs. In a nationwide registry we sought to analyse trends of patients characteristics, complications and in-hospital case-fatality of patients undergoing CTO in Germany.

Methods and Results: We analysed data on patient characteristics, treatments and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) with concomitant presence of procedural code of chronic total occlusion recanalization (OPS code: 8-839.9) in Germany between 2005 and 2020 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, and own calculations). 4,998,457 inpatients aged ≥18 years with diagnoses of CAD were treated in German hospitals in this time period. Among these, 52,879 patients (1.1%) were treated with the diagnosis of chronic total occlusion (CTO). The majority of patients were male (80.5%), had a median age of 66 years and a median hospital stay of 3 days. The annual number of CTO cases increased from 1,263 in 2009 to 6,435 in 2020 (β 3.48 [95% CI 3.44 to 3.52]; p<0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β -0.60 [95% CI -0.82 to -0.39]; p<0.001). Overall, 754 (1.4%) patients with CTO died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73 to 0.90]; p<0.001) (Figure 1). Most patients with CTO were treated in hospitals in urban areas (n = 27,668); proportion rate of mortality was highest in rural (1.7%) compared to those patients treated in suburban (1.2%) or urban (1.3%) areas. Important predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, necessity of erythrocyte concentrates transfusion, haemopericardium, acute renal failure and pulmonary embolism.

Conclusion:

In the present study, we found that the annual number of CTO PCI increased from 2009 to 2020 with a decrease of the case-fatality. Our findings may help to draw more attention to predictors for in-hospital case fatality in patients hospitalized for CTO recanalization.