Abstract 4364350: Impact of Prior Myocardial Infarction on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Background: The impact of prior myocardial infarction (MI) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains understudied. Methods: We compared the characteristics and outcomes of 15,461 patients with versus without history of prior MI who underwent 15,478 CTO PCIs between 2012-2025 at 58 US and non-US centers (PROGRESS-CTO registry). Results: 43.2% (n=6,677) of the patients had history of prior MI. Prior MI patients were younger and more likely to be men, to have hypertension, lower left ventricular ejection fraction, cerebrovascular and peripheral arterial disease. Patients with prior MI that did not have prior PCI (22.8%), were more likely to have a myocardial viability test performed (32.6% vs 27.3%, p<0.001). The lesions of patients with prior MI had higher J-CTO (2.41 vs 2.34, p<0.001) and PROGRESS-CTO (1.25 vs 1.16, p<0.001) scores, higher lesion diameter, longer lesion length, were more likely to have proximal cap ambiguity (35.5% vs 33.8%, p=0.035), side branch at the proximal cap (58.3% vs 56.2%, p=0.014) and moderate/severe tortuosity (28.8% vs 24.6%, p<0.001). They had higher use of the retrograde wiring technique (33.3% vs 29.4%, p<0.001), longer procedural and fluoroscopy times and higher contrast and radiation use. Prior MI cases had lower technical (85.6% vs 88.8%, p<0.001) and procedural (84.3% vs 87.7%, p<0.001) success, but similar major adverse cardiac events (MACE) (2.1% vs 1.7%, p=0.113). They were more likely to experience in-hospital acute MI (0.6% vs 0.4%, p=0.046), coronary perforation (5.0% vs 4.3%, p=0.039) and have elective peripheral ventricular assist device use (2.3% vs 1.7%, p=0.006). In multivariable analysis, prior MI was independently associated with lower technical success (odds ratio (OR) 0.79, 95%CI 0.70-0.89). For 3,546 prior MI cases (53.1%) data regarding the location of the prior MI was available. Most (53.6%) had prior MI in the area that was perfused by the totally occluded vessel. These cases were more likely to have a prior myocardial viability test (29.6% vs 19.7%, p<0.001), had lower technical (83.9% vs 86.3%, p=0.052), with the association persisting in the multivariable analysis (OR 0.62, 95%CI 0.47-0.83), but similar procedural success (82.9% vs 85.2%, p=0.063) and MACE (1.7% vs 1.5%, p=0.712). Conclusions: Patients with prior MI undergoing CTO PCI have more comorbidities and higher lesion complexity, achieve lower technical success but have similar MACE.