Background: Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention.Methods: We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO).Results: Of the 12 928 patients who underwent CTO percutaneous coronary intervention between 2012 and 2022, 52 (0.4%) died during the index hospitalization. Patients who died were more likely to have a history of heart failure (43% versus 28%;P=0.023). The J-CTO ([Multicenter CTO Registry of Japan]; 2.8±1.1 versus 2.4±1.3;P=0.019), PROGRESS-CTO mortality (2.6±0.9 versus 1.6±1.1;P<0.001), and PROGRESS-CTO pericardiocentesis (2.9±1.1 versus 1.9±1.3;P<0.001) scores were higher in patients who died. In these patients, the use of left ventricular assist devices was also higher (41% versus 3.5%;P<0.001), and retrograde crossing was more often the first crossing strategy (33% versus 13%;P<0.001). The cause of death was cardiac in 43 patients (83%) and noncardiac in 9 patients (17%). Complications leading to cardiac death were: tamponade in 30 patients (58%), acute myocardial infarction in 9 (17.3%), and cardiac arrest/shock in 4 (7.7%). Noncardiac causes of death were: stroke in 3 (5.8%), renal failure in 2 (3.8%), respiratory distress in 2 (3.8%), and hemorrhagic shock in 2 (3.8%).Conclusions: Approximately 0.4% of patients who underwent CTO percutaneous coronary intervention died during the index hospitalization. The main cause of death was tamponade in 58%. PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO percutaneous coronary intervention.Registration: URL:https://www.clinicaltrials.gov; Unique Identifier: NCT02061436.

The authors examined parameters associated with successful chronic total occlusion (CTO) crossing using antegrade wiring technique as the initial strategy in CTO percutaneous coronary intervention. Original Contribution from Journal of Invasive Cardiology. Chronic Total Occlusion percutaneous coronary intervention CTO-PCI primary antegrade wiring

Objective: Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. Material and Methods: In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1 -and 6-month follow-ups. Results: According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53 +/- 38.51 g vs. 212.69 +/- 40.82 g; 99.05 g/m(2) (90.00-116.5) vs. 106.0 g/m(2) (96.0 similar to 123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22 +/- 40.07 g vs. 207.52 +/- 41.61 g; 101.0 g/ m(2) (92.25-111.75.0) vs. 104.50 g/m(2) (95.0 similar to 116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). Conclusion: Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post -myocardial infarction cardiac remodeling.

This study examines the clinical characteristics and procedural outcomes of acute coronary syndrome patients who underwent CTO-PCI in the PROGRESS-CTO registry.