Background Information 

PROGRESS-CTO (PROspective Global REgiStry for the Study of Chronic Total Occlusion Intervention) is a multi-center, international registry of chronic total occlusion (CTO) Percutaneous Coronary Intervention (PCI).  A new analysis of the registry presented at SCAI 2022 highlighted the evolution of CTO PCI techniques since the registry opened in 2012.  Clinical and angiographic data data and procedural outcomes of 10,249 CTO PCI’s performed on 10,019 patients between 2012 and 2022 was analyzed. 

Why is this study important? 

Since the inception of the CTO PCI registry, there have been ten years of data collected on 10,019 patients treated at 40 US and non-US centers. The techniques and, thus, outcomes for CTO PCI have evolved over time. The large volume, prospective data presented in this publication provides insight into real-world in-hospital trends and outcomes.  

What questions is this study supposed to answer? 

  • How have the lesion and patient characteristics of CTO interventions changed? 
  • Have the approach to CTO PCI and the procedural success rates changed over time? 

What did the study show? 

  • The mean age of patients was 64+/-10 years and the majority (81%) were men. 
  • 43% of patients were diabetic. 
  • Prior PCI was common (62%). Rate of prior CABG was also high (29%). 
  • The RCA was most commonly treated (53%) with the LAD and left circumflex less commonly targeted at 26% and 19%, respectively. 
  • Lesions with high J-CTO and PROGRESS-CTO scores remained high over the years (2.4 +/- 1.3 and 1.3+/- 1.0, respectively) while the contrast volume, radiation dose, fluoroscopy time and procedure time have continued to decrease.  
  • It is no surprise with the advancement of techniques in CTO PCI that the technical success rate for these interventions has increased over time (overall 86%).  In 2016, the rate of technical success was 81.6%, but by 2021, this had increased to 88.1%. 
  • The majority of successful CTO lesion crossing was done with antegrade wire escalation strategy (55%).  Only 19% were crossed retrograde and 12% antegrade dissection reentry. 
  • Successful crossing with antegrade wire escalation strategy has increased from 46% in 2016 to 61% in 2021. 
  • Importantly, the rate of in-hospital major adverse cardiac events (MACE) remains low (2.1%) without significant changes over time, despite increasing lesion complexity. 

All editors: Allison G. Dupont, MD, FSCAI