Chronic total occlusion (CTO) has emerged as a frequent finding during a percutaneous coronary intervention (PCI), contributing to the increased complexity of the procedure. PCI for CTO is a challenging procedure that requires advanced techniques and skilled operators. Several risk factors have been reported to be linked with the presence of a CTO, determining its outcomes. We sought to identify the risk factors associated with the success rates of the CTO-PCI procedures. This study aims to discover the risk factors that influence the success rates of CTO-PCI procedures.

This study is an observational retrospective cohort devising data from a single-center PCI experience registry at Integrated Heart Service Center, General Academic Hospital Dr. Soetomo, Surabaya, East Java, Indonesia. We identified CTO patients undergoing PCI from January 2022 to December 2022 with various ranges of risk factors. Baseline characteristics, including the symptoms of patients, history of clinical condition, history of medication, physical examination, electrocardiography, chest X-ray, laboratory finding, echocardiography, also angiographic and procedural characteristics were obtained and analyzed. The outcome measurement of successful PCI is determined when the CTO lesion had been successfully crossed for further intervention procedures. Univariate and multivariate logistic regression were performed with SPSS 26.0.

Among 882 patients undergoing PCI, 109 (12.36%) patients were identified with CTO, and most of the patients were male (88.1%). The mean and standard deviation of age were 58.99 (9.45) years, with 57.45 (8.83) years was the age in the successful PCI group, while the failed PCI group showing the age of 61.53 (9.99) (p<0.05). The prevalence of CTO was greater in the urban area (60.6%) (p<0.05) and in white-collar job group (38.5%) (p<0.05) compared to  rural area and blue-collar or no job group, respectively. From multivariate analysis of several characteristics showing p<0.25 in univariate analysis, bradycardia, pathological T inversion on ECG, anaemia in laboratory finding, and angiographic characteristics showing CTO in LAD vessel, CTO in LCX vessel, long lesion of CTO, also CTO lesion with blunt stump and side branch, were the independent factors of CTO-PCI success (p<0.05).

Pathological T inversion from ECG characteristic, anaemia in laboratory finding, and several angiographic characteristics including CTO located in LAD and LCX vessel, long lesion of CTO, also CTO with blunt stump and side branch, are the independent factors of CTO-PCI success. Future study with larger cohort is needed to confirm these findings.