Chronic Total Occlusion PCI in Cancer Patients: National Trends and Periprocedural Risk Stratification
Adrian Nubla, Hugo Lopez‐Arevalo, Keerthana Manjunath, Bilal Bajwa, Marco Dispagna, Yousif Mohammed‐Helo, Revati VarmaABSTRACT
Background
Outcomes of chronic total occlusion (CTO) PCI in patients with active malignancy remain poorly characterized. We examined cancer prevalence trends and in‐hospital outcomes among cancer patients undergoing CTO PCI nationally.
Methods
We analyzed the National Inpatient Sample (2016–2022), identifying CTO PCI admissions using ICD‐10‐CM/PCS codes. Survey‐weighted multivariable logistic regression and inverse probability of treatment weighting (IPTW) compared outcomes in cancer versus no‐cancer patients. Myelosuppression was examined as a prespecified high‐risk subgroup.
Results
Among 214,365 weighted CTO PCI admissions, 4135 (1.9%) involved active cancer. Although absolute CTO PCI volume declined, the proportion of recipients with active cancer increased over the study period (survey‐weighted odds ratio [OR]/year 1.065, 95% confidence interval [CI] 1.028–1.104, p = 0.0007). Despite higher unadjusted mortality (5.2% vs. 3.7%), cancer was not independently associated with higher in‐hospital mortality after multivariable adjustment (adjusted OR [aOR] 0.91, 95% CI 0.63–1.32, p = 0.62) or IPTW (aOR 1.14, 95% CI 0.76–1.70, p = 0.54). In an exploratory subgroup, myelosuppression was associated with more than twofold higher mortality (aOR 2.59, 95% CI 1.07–6.29, p = 0.037); though this finding is hypothesis‐generating given the small sample ( n = 44).
Conclusions
Active malignancy was not independently associated with in‐hospital mortality among patients selected for CTO PCI, though findings cannot establish broad procedural safety given the pre‐selected cohort. Myelosuppression and elevated transfusion risk represent periprocedural considerations warranting prospective validation.