Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural success in elderly patients (≥75 years) with chronic total occlusion

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains the most technically challenging procedure in the contemporary era. The availability of new sophisticated guidewires and other specialized technologies, especially the retrograde approach [1–3] and antegrade dissection and re-entry [4,5], have marked improved the interventional procedure success rate. As the population is progressively aging, the number of patients suffering from coronary artery diseases with CTO is expected to rise in the next decades. Elderly patients with CTO have a greater burden of concomitant diseases compared with young patients [6]. The complexity of the clinical conditions and the increased risk associated with a specific treatment often affect doctors’ decision, making patients’ families more inclined to choose a conservative drug treatment or PCI, instead of coronary artery bypass graft. However, scarce evidence-based data are available on the safety and efficacy of PCI in the elderly CTO patients because of their exclusion and under-representation in clinical trials. Therefore, it is of great clinical and social significance to study the interventional treatments associated with CTO disease in elderly patients, including success rate, safety, and effectiveness. Emerging studies showed that a successful PCI procedure for CTO is associated with better clinical outcomes in terms of reduced mortality and major adverse cardiac events [7–11]. To enhance the procedural success and risk–benefit ratio of CTO PCI, the pre-procedural accurate evaluation is particularly significant because it would help the procedural planning and/or the need to transfer patients to another experienced center. Because of the above purpose, various scoring systems have been developed to predict CTO PCI procedural success, including the J-CTO (Multicenter CTO Registry in Japan) score [12], the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Score [13], the clinical and lesion-related (CL) score [14], and the ostial location, Rentrop grade < 2, age ≥ 75 years (ORA) score [15]. However, the clinical data on the one that is more suitable for CTO patients have not been well established. Therefore, this study is a retrospective cohort report from a Chinese single center, presenting the clinical characteristics of elderly patients ( ≥ 75 years) with CTO diseases and in-hospital outcomes after PCI in the contemporary era. Another aim of this study is to assess different scoring systems in predicting the procedural success in the real world to enhance PCI clinical safety and efficacy.