Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions

Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions Jin Li, Genrui Chen, Huan Wang·, Yue Cai·, Youhu Chen·, Xiaolin Lei·, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7582516/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background We aimed to explore the predictive factors and one-year clinical outcomes following successful contemporary CTO-PCI. Methods Consecutive patients from January 2018 to December 2020 were enrolled. The primary endpoint was major adverse cardiovascular events (MACE) which included all-cause death and myocardial infarction, while target vessel revascularization (TVR) was defined as the secondary endpoint, all of which were measured at 12 months. Results A total of 830 patients were treated by successful CTO PCI, and 96.7% of these cases were available with one-year follow-up data (n = 803). The incidence of MACE was observed in 27 patients (3.4%), with all-cause death occurring in 21 cases (2.6%) and myocardial infarction in 6 cases (0.7%). TVR occurred in 35 patients (4.4%). The multivariate predictive factor analysis for MACE indicated that LVEF < 40% ( P = 0.007) and residual SYNTAX score ≥ 12 ( P < 0.001) was identified as independent risk factors for MACE. While prior PCI ( P = 0.017) and aspirin usage ( P < 0.001) were protective factors. Parallelly, prior PCI and proximal cap ambiguity ( P < 0.001), and guide-wire manipulation time ( P = 0.008) were independent risk factors for TVR, while LAD-CTO presence ( P = 0.045) and stent implantation ( P = 0.001) were protective factors. Conclusion Patients deserved favorable outcomes and a low incidence of adverse events after one year following successful contemporary CTO PCI. Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI) Major Adverse Cardiovascular Events (MACE) Target Vessel Revascularization (TVR) Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) patients has become a well-established revascularization procedure in recent years 1 , 2 . Successful CTO PCI has been shown to effectively relieve symptoms, improve cardiac function, and potentially decrease adverse cardiovascular events 3 – 5 . With advancements in technology and techniques, the procedural success rate now reaches around 95% for experienced operators, making contemporary CTO PCI even more efficient and safer 6 . Previous studies have indicated that left ventricular ejection fraction (LVEF) and CTO lesion length are predictors of outcomes for these specific patients 7 , 8 . However, few studies have systematically investigated the predictors of mid-term outcomes, particularly the factors related to angiographic characteristics and procedural results. This study aimed to identify and describe the predictive factors influencing clinical outcomes one year after CTO PCI. Methods Study Population. Consecutive patients who underwent successful CTO PCI at the Department of Cardiology in Xijing Hospital between January 2018 and December 2020 were prospectively included in this study. The Ethics Committee of the First Affiliated Hospital of Air Force Military University approved this study, which was conducted in accordance with the principles of the Declaration of Helsinki, and written informed consents were obtained from all patients. Cases enrolled were limited to those with a proximal CTO vessel diameter of ≥ 2.0mm. If the patient had undergone multiple CTO PCI procedures, only the first procedure was included for analysis. After discharge, patients entered the follow-up observation period. Exclusion criteria included incomplete data collection, occlusion of bridging vessels, severe infection or malignancy, significant liver or kidney dysfunction which might result in ineligibility for study inclusion, as well as in-hospital mortality and refusal to provide written informed consent. Ultimately, 803 patients were analyzed statistically. Study Procedure . The primary indication for CTO PCI was the presence of ischemic symptoms, with or without documented myocardial ischemia. The current guidelines recommend CABG as the first choice for patients with coronary heart disease with a high score of SYNTAX (> 32). Therefore, surgical consultations were requested for all patients with a SYNTAX score > 32 in this study. In some cases, surgeons deemed the patients unsuitable for surgery due to multiple clinical comorbidities or cardiac function < 35%. On the other hand, some patients declined surgery due to concerns about the associated surgical risks. Coronary angiography and in-depth review of the angiogram was routinely conducted before the procedure. The operator took the hybrid algorithm as a guide during planning and performing9. Non-CTO lesions were scheduled to be treated during the index procedure or a subsequent staged procedure, depending on the operator's discretion. The CTO crossing attempt was about to stop when it reached the termination condition suggested by the CTO crossing algorithm from the Asia Pacific CTO Club10. All cases received optimal medical treatment according to current guidelines following the index procedure. For a considerable part of the cases with a reference vessel diameter between 2.0 and 2.5mm, a drug-coated balloon (DCB) or purely percutaneous transluminal coronary angioplasty (PTCA) without stent implantation was performed. Demographic and clinical data, coronary angiography results, and CTO-PCI outcomes were collected at baseline. The SYNTAX score was calculated using the online scoring system ( www.syntaxscore.com ) to score all coronary artery lesions with a reference diameter ≥ 1.5mm and lumen diameter stenosis ≥ 50%. The characteristics of CTO lesions involving blunt stump, calcification, bending, occlusion length ≥ 20mm, and previously failed lesion was evaluated by the variables and definitions of the J-CTO score 11 , while proximal cap ambiguity and absence of interventional collaterals were determined by PROGRESS score 12 . A poor distal landing zone was defined as the presence of significant coronary artery disease, the existence of a vital bifurcation at the re-entry zone, or a distal vessel diameter < 2mm. Procedure angiograms were independently evaluated by two experienced interventionists, and clinical follow-up was scheduled at 12 months after CTO PCI via telephone interviews or clinical visits. Study Definition and Endpoint. The primary endpoint was defined as major adverse cardiovascular events (MACE), which included all-cause death and myocardial infarction (MI), and the secondary endpoint was set as target vessel revascularization (TVR) based on the suggestion from the CTO-ARC Consensus Recommendations 13 . The diagnosis of MI was based on the Fourth Universal Definition of Myocardial Infarction 14 . TVR refers to any repeated percutaneous coronary intervention or surgical bypass of the target vessel. The guide wire manipulation time (GMT) was defined as the time required to cross the CTO or abort the procedure. The Dissection and re-entry technique (DART) consists of antegrade dissection and re-entry (ADR) and retrograde dissection and re-entry (RDR), which was performed by contemporary dissection and re-entry (DR) operation pattern with the help of dedicated instrument, such as BridgePoint system in ADR, and antegrade balloon dilatation and GuideZilla extended microcatheter in RDR, irrespective of the crossing guidewire intraplaque or extraplaque. Success in this article refers to technical success, which means achieving TIMI grade 3 blood flow with residual stenosis ≤ 30% of the target CTO lesion. In-hospital complications included periprocedural MI, stroke, emergent repeat TVR with PCI or CABG, life-threatening and major bleeding according to Bleeding Academic Research Consortium criteria, coronary perforation requiring medical or surgical intervention, severe peripheral vascular complications, and acute renal injury. In view of the predictive factor analysis, several continuous variables were grouped into ordinal variables based on previous research, latest guidelines, and the specific index procedure. Pro-brain natriuretic peptide (pro-BNP) was categorized into four levels (< 221pg/ml, 221 ~ 459pg/ml, 459 ~ 1006pg/ml, ≥ 1006pg/ml). LVEF was divided into two groups (< 40%, ≥ 40%) 15 . The pre-procedure and residual Syntax scores were grouped into two categories based on the 75th percentile (pre-procedure SYNTAX score: <37 points, ≥ 37 points; residual SYNTAX score: <12 points, ≥ 12 points). The J-CTO score was classified into two groups (< 3 points, ≥ 3 points). For the procedures which were succeeded with the primary strategy, the median GMT was 20min, and 80min for those which were succeeded with the rescue strategy. Therefore, the GMT was divided into three groups (< 20min, 20 ~ 80min, ≥80min). Statistical Analysis. Normality was assessed using the Shapiro-Wilk statistic. Numerical values were expressed as mean ± standard deviation (SD) or median (interquartile range [IQR]), as appropriate, and compared using the Student’s t -test, Mann-Whitney U test, or Kruskal-Wallis H test. Categorical variables were expressed as percentages and compared using the Pearson chi-square test and Fisher's exact test. The Cox proportional hazard model was used to analyze the predictive factors of MACE and TVR. For all tests, a bilateral test probability of P < 0.05 was considered to represent a statistically significant difference. All statistical analyses were executed using SPSS version 27 (IBM, Armonk, New York). Results Study Population. A total of 1010 CTO-PCI procedures were performed in 891 patients from January 2018 to December 2020, of which 119 procedures were excluded as non-index procedures. 848 success cases were achieved among the remaining 891 CTO PCIs (95.2%). Three cases were excluded due to in-hospital death, nine cases due to advanced cancer, and six cases due to renal insufficiency requiring permanent dialysis treatment. No follow-up data were available in 27 patients, therefore 803 out of 830 patients (96.7%) constituted the analysis set for the study ( Fig. 1 ) . One-year Clinical Outcome. The incidence of MACE was observed in 27 patients (3.4%), with all-cause death occurring in 21 cases (2.6%) and MI occurring in 6 cases (0.7%). TVR occurred in 35 patients (4.4%). Baseline Demographic and Clinical Characteristics. The mean age was 61 ± 11years and 701 patients were male (87.3%). Patients in the MACE group had a significantly lower body mass index (BMI) (23.9 ± 3.7 vs 25.2 ± 3.2, P = 0.047), as well as a lower frequency of PCI history (7.4% vs 32.3%, P = 0.006) and aspirin usage at discharge (70.4% vs 95.1%, P < 0.001) than those in the no-MACE group. However, they had a higher level of BNP [989 (214,3133) vs 312 (114,951), P = 0.005], and a greater prevalence of LVEF < 40% (37.0% vs 15.6%, P = 0.007). In the TVR group, patients had a significantly higher proportion of previous PCI (60.0% vs 30.2%, P < 0.001), a lower rate of LVEF < 40% (2.9% vs 16.9%, P = 0.028), and were less likely to clopidogrel usage at discharge (11.4% vs 28.8%, P = 0.025) (Table 1 ). Table 1 Baseline Demographic and Clinical Characteristics Overall Primary Endpoint Secondary Endpoint non-MACE (n = 776) MACE (n = 27) P Value non-TVR (n = 768) TVR (n = 35) P Value Age, yrs 61 ± 11 61 ± 11 64 ± 11 0.185 61 ± 11 59 ± 12 0.581 Male 701(87.3) 678(87.4) 23(85.2) 0.767 670(87.2) 31(88.6) 1.000 BMI, kg/m 2 25.2 ± 3.2 25.2 ± 3.2 23.9 ± 3.7 0.047 25.2 ± 3.2 24.5 ± 2.9 0.157 Current smoking 297(37.0) 290(37.4) 7(25.9) 0.226 285(37.1) 12(34.3) 0.735 Hypertension 474(59.0) 457(58.9) 17(63.0) 0.672 451(58.7) 23(65.7) 0.411 Diabetes 279(34.7) 272(35.1) 7(25.9) 0.328 267(34.8) 12(34.3) 0.953 Dyslipidemia 479(59.7) 463(59.7) 16(59.3) 0.966 457(59.5) 22(62.9) 0.693 Previous MI 320(39.9) 308(39.7) 12(44.4) 0.620 303(39.5) 17(48.6) 0.281 Heart failure 8(1.0) 7(0.9) 1(3.7) 0.240 8(1.0) 0(0.0) 1.000 Chronic Kidney Insufficiency 25(3.1) 25(3.2) 0(0.0) 1.000 24(3.1) 1(2.9) 1.000 Peripheral vascular disease 22(2.7) 21(2.7) 1(3.7) 0.534 21(2.7) 1(2.9) 1.000 Previous PCI 253(31.5) 251(32.3) 2(7.4) 0.006 232(30.2) 21(60.0) < 0.001 Previous CABG 31(3.9) 30(3.9) 1(3.7) 1.000 28(3.6) 3(8.6) 0.148 Creatinine, µmol/L 90 ± 44 90 ± 45 88 ± 23 0.957 91 ± 45 84 ± 25 0.288 LDL-C, mmol/L 1.9 ± 0.9 1.9 ± 0.9 1.9 ± 0.6 0.679 1.9 ± 0.9 1.9 ± 1.4 0.156 pro-BNP, pg/ml 318(116,1001) 312(114,951) 989(214,3133) 0.005 327(121,1017) 157(66,793) 0.078 pro-BNP grades 0.039 0.171 < 221pg/ml 324(40.3) 317(40.9) 7(25.9) 304(39.6) 20(57.1) 221∼459pg/ml 138(17.2) 134(17.3) 4(14.8) 135(17.6) 3(8.6) 459∼1006pg/ml 142(17.7) 139(17.9) 3(11.1) 136(17.7) 6(17.1) ≥ 1006pg/ml 199(24.8) 186(24.0) 13(48.1) 193(25.1) 6(17.1) LVEF, % 50 ± 10 50 ± 10 47 ± 10 0.063 50 ± 10 51 ± 8 0.646 LVEF < 40% 131(16.3) 121(15.6) 10(37.0) 0.007 130(16.9) 1(2.9) 0.028 Medication at discharge Aspirin 757(94.3) 738(95.1) 19(70.4) < 0.001 725(94.4) 32(91.4) 0.445 Clopidogrel 225(28.0) 218(28.1) 7(25.9) 0.805 221(28.8) 4(11.4) 0.025 Ticagrelor 576(71.7) 557(71.8) 19(70.4) 0.873 546(71.1) 30(85.7) 0.060 ACEI/ARB 657(81.8) 634(81.7) 23(85.2) 0.803 631(82.2) 26(74.3) 0.237 β-blockers 730(90.9) 704(90.7) 26(96.3) 0.502 700(91.1) 30(85.7%) 0.238 Statin 794(98.9) 767(98.8) 27(100.0) 1.000 760(99.0) 34(97.1) 0.332 Values are mean ± SD, median (interquartile range), or n (%). ACEI/ARB = angiotensin-Converting Enzyme Inhibitors/ Angiotensin II Receptor Blockers; BMI = Body Mass Index; BNP = Brain Natriuretic Peptide; CABG = Coronary Artery Bypass Grafting; LDL-C = Low-Density Lipoprotein Cholesterol; LVEF = Left Ventricular Ejection Fraction; MI = Myocardial Infarction; PCI = Percutaneous Coronary Intervention. Baseline Angiographic Characteristics. Nearly half of the patients (44.6%) presented with triple vessel disease, while one-fifth (18.3%) had left main trunk lesion. All patients got a high median pre-procedure SYNTAX score [29 (21,37) points] as well as a high J-CTO score (2.6 ± 1.2) in target lesions. In the MACE group, the preoperative Syntax score was significantly higher [37(24,50) vs 29(21,37), P = 0.011], along with a greater proportion of left main lesions (37.0% vs 17.7%, P = 0.019) and target lesion calcification (59.3% vs 36.5%, P = 0.016), compared to the non-MACE group. In the TVR group, patients had a higher rate of blunt stump (85.7% vs 69.0%, P = 0.035) and proximal cap ambiguity (60.0% vs 32.6%, P = 0.001) than in no TVR group. The proportion of LAD CTO was numerically lower in the no-TVR group (22.9% vs 37.9%, P = 0.072), but no statistical difference was detected (Table 2 ). Table 2 Baseline Angiographic Characteristics Overall Primary Endpoint Secondary Endpoint non-MACE (n = 776) MACE (n = 27) P Value non-TVR (n = 768) TVR (n = 35) P Value Number of diseased vessels Single VD 68(8.5) 67(8.6) 1(3.7) 0.720 65(8.5) 3(8.6) 1.000 Double VD 230(28.6) 224(28.9) 6(22.2) 0.453 218(28.4) 12(34.3) 0.450 Triple VD 358(44.6) 348(44.8) 10(37.0) 0.422 345(44.9) 13(37.1) 0.365 LMCA 147(18.3) 137(17.7) 10(37.0) 0.019 140(18.2) 7(20.0) 0.791 Pre-procedure SYNTAX score SYNTAXscore(Q L ,Q U )] 29(21,37) 29(21,37) 37(24,50) 0.011 29(21,38) 26(17,33) 0.117 Pre-procedure SYNTAX≥37 score ≥37 201(25.0) 188(24.2) 13(48.1) 0.005 196(25.5) 5(14.3) 0.133 Number of CTO vessels 1.3 ± 0.5 1.3 ± 0.5 1.5 ± 0.8 0.057 1.3 ± 0.5 1.2 ± 0.5 0.586 CTO Target vessel LMCA 6(0.7) 6(0.8) 0(0.0) 1.000 6(0.8) 0(0.0) 1.000 LAD 299(37.2) 290(37.4) 9(33.3) 0.670 291(37.9) 8(22.9) 0.072 CX 74(9.2) 73(9.4) 1(3.7) 0.502 69(9.0) 5(14.3) 0.362 RCA 424(52.8) 407(52.4) 17(63.0) 0.282 402(52.3) 22(62.9) 0.223 In-stent occlusion 64(8.0) 63(8.1) 1(3.7) 0.716 60(7.8) 4(11.4) 0.516 Ostial lesion 82(10.2) 77(9.9) 5(18.5) 0.183 77(10.0) 5(14.3) 0.391 Blunt stump 560(69.7) 540(69.6) 20(74.1) 0.618 530(69.0) 30(85.7) 0.035 Proximal cap ambiguity 271(33.7) 264(34.0) 7(25.9) 0.382 250(32.6) 21(60.0) 0.001 Calcification 299(37.2) 283(36.5) 16(59.3) 0.016 287(37.4) 12(34.3) 0.712 Tortuosity > 45° 579(72.1) 560(72.2) 19(70.4) 0.838 550(71.6) 29(82.9) 0.147 reference vessel diameter, mm 3.0 ± 0.4 3.0 ± 0.4 3.0 ± 0.4 0.986 3.0 ± 0.4 2.9 ± 0.4 0.380 Lesion length, mm 27 ± 15 27 ± 15 27 ± 15 0.914 27 ± 15 30 ± 15 0.115 Lesion length ≥ 20 mm 552(68.7) 534(68.8) 18(66.7) 0.813 526(68.5) 26(74.3) 0.469 Lack of interventional collaterals 188(23.4) 179(23.1) 9(33.3) 0.216 177(23.0) 11(31.4) 0.252 Diseased distal landing zone 337(42.0) 328(42.3) 9(33.3) 0.355 318(41.4) 19(54.3) 0.131 Reattempt 121(15.1) 117(15.1) 4(14.8) 1.000 114(14.8) 7(20.0) 0.404 J-CTO score 2.6 ± 1.2 2.6 ± 1.2 2.7 ± 0.9 0.570 2.6 ± 1.2 2.9 ± 1.2 0.068 J-CTO score ≥3 470(58.5) 454(58.5) 16(59.3) 0.938 445(57.9) 25(71.4) 0.113 Values are mean ± SD, median (interquartile range), or n (%). CTO = Chronic Total Occlusion; CX = Circumflex artery; J-CTO = Japanese Multicenter CTO Registry; LAD = Left Anterior Descending Artery; LMCA = Left Main Coronary Artery; RCA = Right Coronary Artery; SYNTAX = Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery; VD = Vessel Disease. Procedure Characteristics and Outcomes. Of the 1010 CTO PCIs, 950 technique success (94.1%) were achieved, with 848 (95.2%) in the index PCI (n = 891) and 102 (85.7%) in the non-index PCI (n = 119), which took a higher portion of LCX-CTO as the target lesion (46.2% vs 9.8%, P < 0.001) and a lower inch in the diameter of target vessel [2.75(2.50, 3.00)mm vs 3.00(2.75, 3.25)mm, P < 0.001] than the former. For the index procedure patients (n = 891), 3 cases (0.3%) died respectively from stent thrombosis, cardiac tamponade, and acute myocardial infarction as the main cause of admission. The non-fatal in-hospital complication includes 6 periprocedural myocardial infarctions (0.8%), 2 emergency TVRs (0.2%) (one of whom was referred for CABG), 11 major bleeding (1.2%) (hemopericardium, approach hematoma, and gastrointestinal bleeding), 10 coronary perforations (1.1%) (necessitating the use of pericardiocentesis, covered stents, coils, and thrombin), 18 peripheral vascular complications (2.0%) (mainly resulted from an access-related vascular injury like pseudoaneurysm, arteriovenous fistula, dissection, perforation, pseudoaneurysm, and hematoma), and 2 renal impairments (0.2%). As in the analysis set (n = 803), more than one-half of the procedures (n = 518, 64.5%) succeeded with the AW strategy, 210 of which (26.2%) with Retrograde, the remaining 75 ones (9.3%)with ADR. In the MACE group, the residual Syntax score [10(5,22) vs 7(3,12), P = 0.012], circulation support (14.8% vs 4.6%, P = 0.040), as well as the occurrence of hospital complications (14.8% vs 4.3%, P = 0.031), were higher than those in the non-MACE group (Table 3 ). Table 3 Procedure Characteristics and Outcomes Overall Primary Endpoint Secondary Endpoint non-MACE (n = 776) MACE (n = 27) P Value non-TVR (n = 768) TVR (n = 35) P Value Successful crossing strategy AW 518(64.5) 499(64.3) 19(70.4) 0.517 503(65.5) 15(42.9) 0.006 Rretro 210(26.2) 204(26.3) 6(22.2) 0.636 196(25.5) 14(40.0) 0.057 ADR 75(9.3) 73(9.4) 2(7.4) 1.000 69(9.0) 6(17.1%) 0.128 DART 219(27.3) 211(27.2) 8(29.6) 0.780 204(26.6) 15(42.9) 0.034 GMT, min 30(10,60) 30(10,60) 35(10,67) 0.635 29(10,60) 60(20,107) 0.001 GMT grades 0.733 < 0.001 < 20min 305(38.0) 296(38.1) 9(33.3) 297(38.7) 8(22.9) 20∼80min 362(45.1) 350(45.1) 12(44.4) 350(45.6) 12(34.3) ≥ 80min 136(16.9) 130(16.8) 6(22.2) 121(15.8) 15(42.9) Stent implantation 743(92.5) 717(92.4) 26(96.3) 0.714 714(93.0) 29(82.9) 0.040 Number of stents 2.6 ± 0.9 2.6 ± 0.9 2.7 ± 1.0 0.436 2.6 ± 0.9 2.7 ± 1.1 0.558 Total stent length, mm 79 ± 29 79 ± 29 83 ± 35 0.466 79 ± 29 85 ± 35 0.284 Contrast volume, ml 357 ± 124 357 ± 124 353 ± 121 0.908 354 ± 123 409 ± 134 0.021 Residual SYNTAX score 7(3,12) 7(3,12) 10(5,22) 0.012 7(3,12) 5(2,10) 0.223 Residual SYNTAX score ≥12 216(26.9) 203(26.2) 13(48.1) 0.011 211(27.5) 5(14.3) 0.085 Mechanical Circulatory Support 40(5.0) 36(4.6) 4(14.8) 0.040 39(5.1) 1(2.9) 1.000 In-hospital complications 37(4.6) 33(4.3) 4(14.8) 0.031 36(4.7) 1(2.9) 1.000 Value are mean ± SD, median (interquartile range), or n (%). AW = Antegrade Wiring; ADR = Antegrade Dissection and Re-entry; DART = Dissection and Re-entry techniques; GMT = Guidewire Manipulation Time; Retro = Retrograde; SYNTAX = Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery. Compared with the non-TVR group, the TVR group had lower rates of AW strategy success (42.9% vs 65.5%, P = 0.006) and stent implantation (82.9% vs 93.0%, P = 0.040), while higher DART application rate (42.9% vs 26.6%, P = 0.034), longer GMT [60 (20,107) vs 29 (10,60), P = 0.001]), and more contrast media (409 ± 134 vs 354 ± 123, P = 0.021) (Table 3 ). Analysis of Predictive Factors for One-year MACE The above clinical baseline, coronary angiography features, and intraoperative outcome data were analyzed using univariate analyses. The results suggested that BMS, history of PCI, BNP, LVEF, aspirin usage, left main lesions, number of CTOs, calcification, MCS usage, hospital complications, preoperative Syntax score, and residual Syntax score were variables that might affect MACE. Multivariate analysis showed that PCI history, LVEF, aspirin usage, and residual Syntax score were correlated with the occurrence of MACE. Among these variables, LVEF < 40% (HR = 2.837, 95%CI:1.295–6.215, P = 0.009) and residual Syntax score ≥ 12 (HR = 2.585, 95%CI:1.213–5.509, P = 0.014) were identified as independent risk factors, while PCI history (HR = 0.153, 95%CI:0.036–0.649, P = 0.011) and aspirin usage (HR = 0.129, 95%CI:0.056–0.295, P < 0.001)were found to be protective factors (Fig. 2 A). The Kaplan–Meier plot showed a gradual decline of the MACE-free survival rate over time in both groups after 1-year post-PCI, but a more pronounced decrease was observed in the EF<40% group. The disparity between the two groups demonstrated statistical significance ( P = 0.003) (Fig. 3 A). Consequently, an EF ≥ 40% conferred a protective effect on patients with CTO compared to those with an EF < 40%. Consistently, residual SYNTAX score ≥ 12 brought more risk to the patient within a year after discharge ( P = 0.011). (Fig. 3 B). Analysis of Predictive Factors of One-year TVR. Similarly, univariate analysis for TVR predictors suggests that PCI history, usage of clopidogrel, blunt stump, proximal cap ambiguity, antegrade opening, DART application, GMT, contrast dosage, and DES implantation are significant variables affecting TVR. Additionally, LVEF < 40% and pre-reduced CTO potentially took an important role. Multivariate analysis showed that PCI history, LAD CTO, proximal cap ambiguity, GMT and stent implantation were related to the occurrence of TVR, and PCI history (HR = 2.842, 95%CI: 1.440–5.612, P = 0.003), proximal cap ambiguity(HR = 2.854, 95%CI:1.353–6.019, P = 0.006) and GMT (HR = 1.945, 95%CI:1.190–3.178, P = 0.008) were independent risk factors, while LAD CTO (HR = 0.438, 95%CI:0.195–0.982, P = 0.045) and stent implantation (HR = 0.184, 95% CI:0.069–0.489, P = 0.001) were protective factors (Fig. 2 B). The Kaplan-Meier plot demonstrated the 1-year TVR-free survival rate in the non-ambiguity group was higher than that in the ambiguity group ( P = 0.001) (Fig. 4 A). The impact of GMT on TVR was further confirmed and the results indicated no statistical difference between the < 20min group and the 20-80min group, while significant differences were observed between the ≥ 80min group and both the < 20min group and the 20-80min group ( P < 0.001) (Fig. 4 B). Discussion In recent years, several studies have reported a significantly higher success rate of CTO PCI, making it an increasingly accepted treatment for patients with CTO 6 , 16 . However, limited evidence was found to identify prognostic factors, particularly those related to lesion characteristics and procedure outcomes, that would impact the one-year outcome of patients successfully treated with contemporary CTO PCI. Therefore, we conducted an analysis to identify predictive factors that may influence the one-year outcomes. In this study, the patients had a high proportion of co-morbidities, multivessel disease, and complex CTO lesions. Patients in the MACE group showed a lower BMI, implying the obesity paradox in patients with CTO that higher BMI was associated with better long-term outcome 17 , 18 . Patients with lower DM rates had numerically higher MACEs mainly because of selection bias and short-term follow-up. Most procedures succeeded with the AW strategy, while ADR was utilized in only a minority of cases. Overall procedures were performed with a shorter guidewire manipulation time compared to the report by Tanaka H 19 from the Japanese CTO-PCI expert registry, and with a lower rate of stent implantation compared to the data by Maeremans J 20 from the RECHARGE registry which mainly due to smaller reference diameters. Most of these patients underwent procedures with the utilization of DCBs instead. The incidence of MACE and TVR in the follow-up results was parallelly low, similar to previously published data 21 , 22 . According to the multivariable analysis, strategy and DART performed during the procedure were not associated with the endpoint of MACE. Instead, previous PCI, LVEF, aspirin usage at discharge and residual SYNTAX score played a significant role. Patients with a history of PCI had significantly lower pre-procedure SYNTAX scores compared to those without previous PCI history, indicating a prior aggressive and completely revascularization of non-target lesions for the former ones, which contributes to more effective myocardial protection against ischemia following after index CTO PCI. This study found that all-cause mortality and MACEs were higher in patients with LVEF < 40% compared to those with LVEF ≥ 40% after successful CTO PCI. What needs to be remind is that reduced LV function was associated with a 3-fold increased risk of mortality in patients with CTO lesions undergoing PCI, and patients with reduced LV function also could deserve clear benefits of all-cause mortality reduction after successful CTO PCI than those with procedure failure 23 . This is important for the relatively young population, especially with LV dysfunction. Furthermore, six patients who were not prescribed aspirin at discharge occurred death. These patients were categorized based on their previous gastrointestinal bleeding (2 cases), age ≥ 75 years (1 case), severe anemia resulting in massive blood loss during the procedure (1 case), and use of oral anticoagulation (2 cases). Although death causes for these patients couldn’t be determined, it was an inevitable problem that cases in the MACE group had a higher proportion of not taking aspirin upon discharge. Therefore, it is important to balance antiplatelet therapy with the risk of bleeding for a special population after CTO PCI. CTO lesions are believed to be a characteristic of the end-stage of coronary heart disease, which often is diagnosed as multivessel lesions. Our study results showed that incomplete revascularization was significantly associated with a higher incidence of MACEs following one year follow-up, which aligns with previous findings 24 , 25 . Therefore, the lower the residual SYNTAX score in CTO PCI, the greater the reduction in MACE incidence. Multivariable analysis for TVR revealed that the occurrence of TVR was correlated with a history of PCI, LAD-CTO, proximal cap ambiguity, GMT, and implanted stents. In contrast to the MACE case, a history of PCI was a risk factor for TVR. Previous PCI means an advanced coronary disease development or a proactive intervention. For a CTO patient, a previous proactive intervention brings more benefits in alleviating myocardial ischemia, resulting in the reduction of MACE after successful CTO PCI. Meanwhile, patients with advanced coronary disease development are more likely to get an in-stent restenosis after CTO PCI. Patients with a LAD-CTO are prone to having a lower rate of TVR due to less anatomical tortuosity and less frequent DART employed. But, the impact of DART on TVR remains controversial 26 . Several reports have suggested that the use of DART is not correlated with an increase in TVR. Although the frequency of TVR in the DART group was not significantly higher than that in the wire-based group, there was a noticeable numerical increase, suggesting that DART may potentially increase the risk of TVR. Proximal cap ambiguity is universally recognized as an important adverse characteristic of CTO lesion, for which the retrograde technique is recommended as the primary strategy given the presence of interventional collateral 9 , 12 . For interventional collateral unusable, ADR may be the only option 27 . In this study, proximal cap ambiguity significantly increased TVR, mainly because of DART, lesion length, and time of guidewire tracking extraplaque, as we found procedures with a proximal cap ambiguity had longer lesion lengths, performed more DART, and consumed more GMT. To some extent, longer subintimal tracking and more devices applied in the CTO segment tend to result in a wider subintimal space, which implies more loss of endothelial cells and desmoplasia, leading to restenosis 28 , 29 . The GMT practically indicates the complexity of CTO lesions. The longer GMT consumed, corresponds to the higher the J-CTO score lesion, and more complex techniques and invasive devices are used, and more complications may occur 30 . All these characteristics potentially contribute to a wide subintimal space, injuring the vascular structure, and connective tissue hyperplasia, which may generate more TVR 30 . In this study, pure angioplasty without stent implantation was performed in some cases, however, these cases were more prone to suffer restenosis. Although DCB angioplasty was applied in a small population, no protective effect against TVR similar to stenting was observed. This conclusively prioritizes stenting in the CTO-PCI procedure. This conclusively prioritizes stenting during the CTO-PCI procedure. In comparison to the reports from the United States and Europe, our study population was younger and had a lower proportion of female patients, while similar technique success and in-hospital complications were achieved between males and females, and females were significantly older and had longer lesion length 20 , 31 , 32 . The predictive factors of one-year outcomes were systematically analyzed, involving angiographic characteristics and procedural outcomes. Interestingly, few reports have proposed contradictory effects that a history of PCI took on MACE and TVR, as well as an increased MACE due to discontinuation of aspirin for the high bleeding risk population after CTO recanalization. Proximal cap ambiguity and prolonged GMT was rarely reported as contributing to an increase in TVR. Further research is required to investigate how these factors act mechanically. Study Limitations This is a prospective single-center observational study, which is limited by its inherent susceptibility to selection bias. Each CTO PCI procedure was performed by an experienced interventional cardiologist, and guidewire selection, approach, and crossing strategies were left to the discretion of the operator performing the procedure. Therefore, caution should be exercised when applying these results to clinical practice. Also, there is not a committee for adverse event adjudication. However, considering the purpose of this study, coronary angiographic characteristics and procedure outcomes from a single operator offer consistent data scales, reduce operator bias, and enhance the stability of the results. Conclusions Patients deserved favorable one-year outcomes with a low incidence of MACE and TVR following successful contemporary CTO PCI. For this specific population, LVEF < 40% and residual SYNTAX score ≥ 12 were independent risk factors on MACE, while prior PCI and aspirin usage at discharge were protective factors. Prior PCI, proximal cap ambiguity and GMT were independent risk factors on TVR, while LAD-CTO presence and stent implantation were protective factors. Declarations Acknowledgments None Author contributions G.HK., L.CX for study design. L.J., Ch.GR., W.H., C.Y., Ch. YH., L. XL for data collection; L.J., Ch. GR for data analysis; G.HK. L.CX for supervision; L. J for writing of the original version; G.HK and L. CX for review and revision; All authors reviewed and approved the manuscript Funding This study was supported by the Shaanxi Province Key Research and Development Project (No: 2024GX -YBXM-136). Data availability Correspondence and requests for materials should be addressed to the corresponding author Ethics statement This study was approved by the ethics committee of the Department of Cardiology, the First Affiliated Hospital of Air Force Military Medical University, Xi’an 710032, China. Consent to publish Written informed consent was obtained from the patient for publication of this case report. Competing interests: The authors declare no competing interests. Consent to Participate declaration : not applicable Clinical trial number: not applicable. References Galassi AR et al. Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery. EuroIntervention 20, e174-e184. 10.4244/eij-d-23-00749 (2024). Brilakis ES, et al. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation. 2019;140:420–33. 10.1161/CIRCULATIONAHA.119.039797 . Ahn JH, et al. Impact of Chronic Total Coronary Occlusion Location on Long-term Survival After Percutaneous Coronary Intervention. Rev Esp Cardiol (Engl Ed). 2019;72:717–23. 10.1016/j.rec.2018.07.011 . Hoebers LP, et al. Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol. 2015;187:90–6. 10.1016/j.ijcard.2015.03.164 . Megaly M, et al. Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention. Cardiovasc intervention Ther. 2022;37:483–9. 10.1007/s12928-021-00819-x . Wu EB, et al. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78:840–53. 10.1016/j.jacc.2021.05.055 . Vadalà G et al. Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry. EuroIntervention 20, e185-e197. 10.4244/eij-d-23-00490 (2024). Shoaib A, et al. Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length. Catheter Cardiovasc Interv. 2022;99:234–44. 10.1002/ccd.30015 . Brilakis ES, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5:367–79. 10.1016/j.jcin.2012.02.006 . Harding SA, et al. A New Algorithm for Crossing Chronic Total Occlusions From the Asia Pacific Chronic Total Occlusion Club. JACC Cardiovasc Interv. 2017;10:2135–43. 10.1016/j.jcin.2017.06.071 . Morino Y, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213–21. 10.1016/j.jcin.2010.09.024 . Kim YJ, et al. Immediate complete revascularization showed better outcome in out-of-hospital cardiac arrest survivors with left main or triple-vessel coronary diseases. Sci Rep. 2022;12(1):4354. 10.1038/s41598-022-08383-x . Ybarra LF, et al. Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations. Circulation. 2021;143:479–500. 10.1161/circulationaha.120.046754 . Thygesen K, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40:237–69. 10.1093/eurheartj/ehy462 . Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e263–421. 10.1016/j.jacc.2021.12.012 . Ybarra LF, Rinfret S. Why and How Should We Treat Chronic Total Occlusion? Evolution of State-of-the-Art Methods and Future Directions. Can J Cardiol. 2020. 10.1016/j.cjca.2020.10.005 . Tsai CT, et al. Obesity paradox in patients with chronic total occlusion of coronary artery. Eur J Clin Invest. 2022;52:e13698. 10.1111/eci.13698 . Won KB, et al. Comparison of long-term mortality according to obesity in patients with successful percutaneous chronic total occlusion interventions using drug-eluting stents. Catheter Cardiovasc Interv. 2018;91:710–6. 10.1002/ccd.27110 . Tanaka H, et al. A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion. J Am Coll Cardiol. 2019;74:2392–404. 10.1016/j.jacc.2019.08.1049 . Maeremans J, et al. The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry. J Am Coll Cardiol. 2016;68:1958–70. 10.1016/j.jacc.2016.08.034 . Wilson WM, et al. One-year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re-entry techniques. Catheter Cardiovasc Interv. 2017;90:703–12. 10.1002/ccd.26980 . Galassi AR, et al. Wire-based antegrade dissection re-entry technique for coronary chronic total occlusions percutaneous revascularization: Experience from the ERCTO Registry. Catheter Cardiovasc Interv. 2023;102:864–77. 10.1002/ccd.30827 . Toma A, et al. Survival after percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol. 2016;105:921–9. 10.1007/s00392-016-1000-2 . Azzalini L, et al. Impact of Incomplete Revascularization on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol. 2018;121:1138–48. 10.1016/j.amjcard.2018.01.033 . Abouzaki NA, Exaire JE, Guzmán LA. Role of Percutaneous Chronic Total Occlusion Interventions in Patients with Ischemic Cardiomyopathy and Reduced Left Ventricular Ejection Fraction. Curr Cardiol Rep. 2018;20:124. 10.1007/s11886-018-1066-8 . Maeremans J, et al. One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: A Subanalysis of the Multicenter RECHARGE Registry. J Invasive Cardiol. 2018;30:62–70. Park Y, et al. Intravascular ultrasound guided recanalization of stumpless chronic total occlusion. Int J Cardiol. 2011;148:174–8. 10.1016/j.ijcard.2009.10.052 . Karatasakis A, et al. Impact of Proximal Cap Ambiguity on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter US Registry. J Invasive Cardiol. 2016;28:391–6. Megaly M, et al. Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv. 2022;100:1021–9. 10.1002/ccd.30403 . Miura K, et al. Impact of Timing and Treatment Strategy on Coronary Perforation During Percutaneous Coronary Intervention for Chronic Total Occlusion. Am J Cardiol. 2022;172:26–34. 10.1016/j.amjcard.2022.02.019 . Avran A, et al. Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study. Catheter Cardiovasc Interv. 2023;101:918–31. 10.1002/ccd.30616 . Tajti P, et al. The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry. JACC Cardiovasc Interv. 2018;11:1325–35. 10.1016/j.jcin.2018.02.036 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7582516","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":524535357,"identity":"410ab2a8-7854-4b87-9b4c-b468d008ec23","order_by":0,"name":"Jin Li","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Li","suffix":""},{"id":524535358,"identity":"41b387f5-6c51-4502-b711-fbc0f4a65d74","order_by":1,"name":"Genrui Chen","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Genrui","middleName":"","lastName":"Chen","suffix":""},{"id":524535359,"identity":"2a1021db-7ccc-4a0b-9086-02178354a816","order_by":2,"name":"Huan Wang·","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Wang·","suffix":""},{"id":524535360,"identity":"616b03ea-7a11-4e26-acc0-549d53725c7a","order_by":3,"name":"Yue Cai·","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Cai·","suffix":""},{"id":524535361,"identity":"f327ec94-6475-4ce5-aadb-e4ae5841f3b0","order_by":4,"name":"Youhu Chen·","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Youhu","middleName":"","lastName":"Chen·","suffix":""},{"id":524535362,"identity":"6b456dc0-5ec8-4761-a595-73f841bdfa2a","order_by":5,"name":"Xiaolin Lei·","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaolin","middleName":"","lastName":"Lei·","suffix":""},{"id":524535363,"identity":"752896b9-0766-4e3f-b26d-ce8cad66de7b","order_by":6,"name":"Chengxiang Li","email":"","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chengxiang","middleName":"","lastName":"Li","suffix":""},{"id":524535364,"identity":"13b79301-7c46-42d7-99ab-3e7ca8461bad","order_by":7,"name":"Haokao Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArklEQVRIiWNgGAWjYBACAx4wZcPDz99AmpY0GckZB0jTctjGoCGBSC3mPAeYX/yoOM9jwHCA8cPHHCK0WPY2sFn2nLnNY87cwCw5cxsxDjvPwGbA23abx7LhABszL7FaDP+2neMxOJBArJazDcyPedsOkKLlDNA9MmeSeSRnHGwm0i9nEpg/vqmws+fnbz744SMxWhgY+L9JQBiMDUSpBwHmD0QrHQWjYBSMgpEJANXjNLJJqTftAAAAAElFTkSuQmCC","orcid":"","institution":"the First Affiliated Hospital of Air Force Military Medical University","correspondingAuthor":true,"prefix":"","firstName":"Haokao","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2025-09-10 11:38:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7582516/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7582516/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93008886,"identity":"a5bf6ce2-b85c-4b45-b5cd-6f9c7469f74d","added_by":"auto","created_at":"2025-10-08 07:05:34","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":225266,"visible":true,"origin":"","legend":"","description":"","filename":"maintext.docx","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/5e69c93a93e586df00dbab36.docx"},{"id":93008887,"identity":"db5649df-4d36-41ab-bee5-ef75885ebd3a","added_by":"auto","created_at":"2025-10-08 07:05:34","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1051064,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1Flowchart.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/13bda9e939e6ea80841bd1bd.tif"},{"id":93008892,"identity":"fbf57fd1-1dbf-46c8-864d-db43ef16f1ea","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2064164,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/fedb8811e67ed292eb22958a.tif"},{"id":93010390,"identity":"5687a6f1-6017-476d-a148-8097344e05ef","added_by":"auto","created_at":"2025-10-08 07:13:35","extension":"tif","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1229164,"visible":true,"origin":"","legend":"","description":"","filename":"Figure.3.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/94921d2531bbcea539708311.tif"},{"id":93008897,"identity":"b5888661-4ca9-4296-917d-b3854fa62727","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1501728,"visible":true,"origin":"","legend":"","description":"","filename":"Figure.4.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/3f0e86131619974744a299b6.tif"},{"id":93012187,"identity":"f62aff90-d189-4f75-b131-38ccf0cc6957","added_by":"auto","created_at":"2025-10-08 07:21:35","extension":"json","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8680,"visible":true,"origin":"","legend":"","description":"","filename":"db27c1a0ab0d4d25a78098a6779cc59a.json","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/4e6653b9c84c29cd0b571adb.json"},{"id":93008903,"identity":"76e08fe8-b6be-46cb-8e42-4beb615ec4ae","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":147574,"visible":true,"origin":"","legend":"","description":"","filename":"db27c1a0ab0d4d25a78098a6779cc59a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/2f6a7e367647d0bde218c358.xml"},{"id":93008894,"identity":"f0896c22-a585-452e-8f42-3fbc833afa7e","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1051064,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1Flowchart.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/8d78c480343e7ce2dcc1ea23.tif"},{"id":93008891,"identity":"603ee9fe-bd16-4a9b-9aeb-009657dfbd34","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2064164,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/40eaf0abd4915aa5d30332ab.tif"},{"id":93008902,"identity":"173f65b0-f89b-4da4-8bd2-a133d7e7987d","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1229164,"visible":true,"origin":"","legend":"","description":"","filename":"Figure.3.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/f2a9e7cacaacb9a49e53335b.tif"},{"id":93008907,"identity":"34fb7e9f-4100-4f78-9b41-67e8091a02b2","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"tif","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1501728,"visible":true,"origin":"","legend":"","description":"","filename":"Figure.4.tif","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/9da9b4eb6f73ae41649fef85.tif"},{"id":93008901,"identity":"a5829c89-fd4f-4f3a-befa-e0e1065194de","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":318289,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure1Flowchart.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/8a8b1f94f93b0809dc0d8487.png"},{"id":93010393,"identity":"d2c51b9e-eb67-4353-a15a-abf0b4ba43ac","added_by":"auto","created_at":"2025-10-08 07:13:35","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1081131,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/6a74e2585d44eb10c7a8b0b8.png"},{"id":93008905,"identity":"2cb90eee-6f7e-495c-947f-bc48a333672c","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138821,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure.3.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/08db10dd97a1defbe973357a.png"},{"id":93008904,"identity":"71230a1a-035f-4af8-9f77-32250089b7dc","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164786,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure.4.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/969ae10d50d647767bedd686.png"},{"id":93008898,"identity":"d973f153-ad08-4b75-98e3-c8ae22a924fd","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":145247,"visible":true,"origin":"","legend":"","description":"","filename":"db27c1a0ab0d4d25a78098a6779cc59a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/7cace90ec65eb61e7d4a999d.xml"},{"id":93008900,"identity":"284467f1-6cdb-434d-b407-fc9b659ebd95","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155487,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/4480f5b2f5a677e36275f5be.html"},{"id":93012186,"identity":"b2530890-8c57-4b81-89ad-af79beeedd57","added_by":"auto","created_at":"2025-10-08 07:21:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":347584,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e: Patient flow chart.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend\u003c/strong\u003e: CTO: chronic total occlusion; PCI: percutaneous coronary intervention;\u003c/p\u003e","description":"","filename":"Figure1Flowchart.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/3e3ac7a0b96f8dc413291915.png"},{"id":93010388,"identity":"d2aae799-52a1-4306-a63d-e9cd3efc6dc2","added_by":"auto","created_at":"2025-10-08 07:13:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":327208,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e: Predictors of one-year MACE (A) and TVR (B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend\u003c/strong\u003e: A: LVEF\u0026lt;40% and residual Syntax score ≥12 were identified as independent risk factors, while PCI history and aspirin at discharge were found to be protective factors. B: Previous PCI, proximal cap ambiguity, and GMT were detected as independent risk factors, while LAD CTO and stent implantation were protective factors. MACE: major adverse cardiovascular events; TVR: target vessel revascularization; R-SYNTAX score: residual SYNTAX score; PCI: percutaneous coronary intervention; LVEF: left ventricular ejection fraction; LAD: left: left anterior descending (coronary artery); CTO: chronic total occlusion; GMT: guidewire manipulation time;\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/2db561a9200330aed18d26f6.png"},{"id":93008890,"identity":"bdc3020e-8ef0-4966-b669-0d8d99e7e6d9","added_by":"auto","created_at":"2025-10-08 07:05:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":286985,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e: Survival curves for freedom from the cumulative incidence of MACE according to LVEF (\u0026lt;40% vs ³40%) and Residual SYNTAX score (\u0026lt;12 vs ³12).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend\u003c/strong\u003e: A: Within one year after CTO PCI, the MACE-free survival rate gradually declined over time in both groups, with a more pronounced decrease observed in the group with an EF＜40%. The disparity between the two groups demonstrated statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.05). B: A consistent result on different degrees of residual SYNTAX score with EF value in both groups.\u003c/p\u003e\n\u003cp\u003eCTO=Chronic total occlusion; LVEF=Left ventricular ejection fraction; MACE=Major adverse cardiovascular events; PCI=Percutaneous coronary intervention;\u003c/p\u003e","description":"","filename":"Figure.3.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/6d9b77aa03adef2320c31fb1.png"},{"id":93008893,"identity":"36e9f8d6-09e0-4e96-a41c-e64ab15b9b01","added_by":"auto","created_at":"2025-10-08 07:05:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":320185,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e: Survival curves for freedom from the cumulative incidence of TVR according to Proximal Cap (ambiguity vs. non-ambiguity) and Guidewire Manipulation Time (\u0026lt;20min vs. 20~80min vs. ³80min).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend\u003c/strong\u003e: A: The 1-year TVR-free survival rate in the non-ambiguity group was higher than that in the ambiguity group. B: Three groups according to GMT exhibit notable variations in their influence on TVR, with the GMT ≥80min group demonstrating the most substantial decline in one-year TVR-free survival rate. Specifically, compared to both the \u0026lt;20min and 20-80 min groups, the ≥80minute group had a lower rate (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001); however, no statistically significant difference between the former two groups was detected. TVR: target vessel revascularization; GMT = guidewire manipulation time;\u003c/p\u003e","description":"","filename":"Figure.4.png","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/8501ee45c46a8d7e9b4a8dc2.png"},{"id":96803197,"identity":"04ad85bc-0df9-4bb8-89bc-362056b957f4","added_by":"auto","created_at":"2025-11-26 08:54:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2442582,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7582516/v1/6c87a080-ddf4-40d3-8e6f-1a94b3bda870.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePercutaneous coronary intervention (PCI) for chronic total occlusion (CTO) patients has become a well-established revascularization procedure in recent years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Successful CTO PCI has been shown to effectively relieve symptoms, improve cardiac function, and potentially decrease adverse cardiovascular events\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. With advancements in technology and techniques, the procedural success rate now reaches around 95% for experienced operators, making contemporary CTO PCI even more efficient and safer\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious studies have indicated that left ventricular ejection fraction (LVEF) and CTO lesion length are predictors of outcomes for these specific patients\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, few studies have systematically investigated the predictors of mid-term outcomes, particularly the factors related to angiographic characteristics and procedural results. This study aimed to identify and describe the predictive factors influencing clinical outcomes one year after CTO PCI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Population.\u003c/b\u003e Consecutive patients who underwent successful CTO PCI at the Department of Cardiology in Xijing Hospital between January 2018 and December 2020 were prospectively included in this study. The Ethics Committee of the First Affiliated Hospital of Air Force Military University approved this study, which was conducted in accordance with the principles of the Declaration of Helsinki, and written informed consents were obtained from all patients. Cases enrolled were limited to those with a proximal CTO vessel diameter of \u0026ge;\u0026thinsp;2.0mm. If the patient had undergone multiple CTO PCI procedures, only the first procedure was included for analysis. After discharge, patients entered the follow-up observation period. Exclusion criteria included incomplete data collection, occlusion of bridging vessels, severe infection or malignancy, significant liver or kidney dysfunction which might result in ineligibility for study inclusion, as well as in-hospital mortality and refusal to provide written informed consent. Ultimately, 803 patients were analyzed statistically.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Procedure\u003c/b\u003e. The primary indication for CTO PCI was the presence of ischemic symptoms, with or without documented myocardial ischemia. The current guidelines recommend CABG as the first choice for patients with coronary heart disease with a high score of SYNTAX (\u0026gt;\u0026thinsp;32). Therefore, surgical consultations were requested for all patients with a SYNTAX score\u0026thinsp;\u0026gt;\u0026thinsp;32 in this study. In some cases, surgeons deemed the patients unsuitable for surgery due to multiple clinical comorbidities or cardiac function\u0026thinsp;\u0026lt;\u0026thinsp;35%. On the other hand, some patients declined surgery due to concerns about the associated surgical risks. Coronary angiography and in-depth review of the angiogram was routinely conducted before the procedure. The operator took the hybrid algorithm as a guide during planning and performing9. Non-CTO lesions were scheduled to be treated during the index procedure or a subsequent staged procedure, depending on the operator's discretion. The CTO crossing attempt was about to stop when it reached the termination condition suggested by the CTO crossing algorithm from the Asia Pacific CTO Club10. All cases received optimal medical treatment according to current guidelines following the index procedure. For a considerable part of the cases with a reference vessel diameter between 2.0 and 2.5mm, a drug-coated balloon (DCB) or purely percutaneous transluminal coronary angioplasty (PTCA) without stent implantation was performed.\u003c/p\u003e\u003cp\u003eDemographic and clinical data, coronary angiography results, and CTO-PCI outcomes were collected at baseline. The SYNTAX score was calculated using the online scoring system (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.syntaxscore.com\u003c/span\u003e\u003cspan address=\"http://www.syntaxscore.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) to score all coronary artery lesions with a reference diameter\u0026thinsp;\u0026ge;\u0026thinsp;1.5mm and lumen diameter stenosis\u0026thinsp;\u0026ge;\u0026thinsp;50%. The characteristics of CTO lesions involving blunt stump, calcification, bending, occlusion length\u0026thinsp;\u0026ge;\u0026thinsp;20mm, and previously failed lesion was evaluated by the variables and definitions of the J-CTO score\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, while proximal cap ambiguity and absence of interventional collaterals were determined by PROGRESS score\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. A poor distal landing zone was defined as the presence of significant coronary artery disease, the existence of a vital bifurcation at the re-entry zone, or a distal vessel diameter\u0026thinsp;\u0026lt;\u0026thinsp;2mm. Procedure angiograms were independently evaluated by two experienced interventionists, and clinical follow-up was scheduled at 12 months after CTO PCI via telephone interviews or clinical visits.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Definition and Endpoint.\u003c/b\u003e The primary endpoint was defined as major adverse cardiovascular events (MACE), which included all-cause death and myocardial infarction (MI), and the secondary endpoint was set as target vessel revascularization (TVR) based on the suggestion from the CTO-ARC Consensus Recommendations\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The diagnosis of MI was based on the Fourth Universal Definition of Myocardial Infarction\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. TVR refers to any repeated percutaneous coronary intervention or surgical bypass of the target vessel.\u003c/p\u003e\u003cp\u003eThe guide wire manipulation time (GMT) was defined as the time required to cross the CTO or abort the procedure. The Dissection and re-entry technique (DART) consists of antegrade dissection and re-entry (ADR) and retrograde dissection and re-entry (RDR), which was performed by contemporary dissection and re-entry (DR) operation pattern with the help of dedicated instrument, such as BridgePoint system in ADR, and antegrade balloon dilatation and GuideZilla extended microcatheter in RDR, irrespective of the crossing guidewire intraplaque or extraplaque. Success in this article refers to technical success, which means achieving TIMI grade 3 blood flow with residual stenosis\u0026thinsp;\u0026le;\u0026thinsp;30% of the target CTO lesion. In-hospital complications included periprocedural MI, stroke, emergent repeat TVR with PCI or CABG, life-threatening and major bleeding according to Bleeding Academic Research Consortium criteria, coronary perforation requiring medical or surgical intervention, severe peripheral vascular complications, and acute renal injury. In view of the predictive factor analysis, several continuous variables were grouped into ordinal variables based on previous research, latest guidelines, and the specific index procedure. Pro-brain natriuretic peptide (pro-BNP) was categorized into four levels (\u0026lt;\u0026thinsp;221pg/ml, 221\u0026thinsp;~\u0026thinsp;459pg/ml, 459\u0026thinsp;~\u0026thinsp;1006pg/ml, \u0026ge;\u0026thinsp;1006pg/ml). LVEF was divided into two groups (\u0026lt;\u0026thinsp;40%, \u0026ge;\u0026thinsp;40%)\u003csup\u003e15\u003c/sup\u003e. The pre-procedure and residual Syntax scores were grouped into two categories based on the 75th percentile (pre-procedure SYNTAX score: \u0026lt;37 points, \u0026ge;\u0026thinsp;37 points; residual SYNTAX score: \u0026lt;12 points, \u0026ge;\u0026thinsp;12 points). The J-CTO score was classified into two groups (\u0026lt;\u0026thinsp;3 points, \u0026ge;\u0026thinsp;3 points). For the procedures which were succeeded with the primary strategy, the median GMT was 20min, and 80min for those which were succeeded with the rescue strategy. Therefore, the GMT was divided into three groups (\u0026lt;\u0026thinsp;20min, 20\u0026thinsp;~\u0026thinsp;80min, \u0026ge;80min).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analysis.\u003c/b\u003e Normality was assessed using the Shapiro-Wilk statistic. Numerical values were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (interquartile range [IQR]), as appropriate, and compared using the Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test, Mann-Whitney \u003cem\u003eU\u003c/em\u003e test, or Kruskal-Wallis \u003cem\u003eH\u003c/em\u003e test. Categorical variables were expressed as percentages and compared using the Pearson chi-square test and Fisher's exact test. The Cox proportional hazard model was used to analyze the predictive factors of MACE and TVR. For all tests, a bilateral test probability of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to represent a statistically significant difference. All statistical analyses were executed using SPSS version 27 (IBM, Armonk, New York).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eStudy Population.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 1010 CTO-PCI procedures were performed in 891 patients from January 2018 to December 2020, of which 119 procedures were excluded as non-index procedures. 848 success cases were achieved among the remaining 891 CTO PCIs (95.2%). Three cases were excluded due to in-hospital death, nine cases due to advanced cancer, and six cases due to renal insufficiency requiring permanent dialysis treatment. No follow-up data were available in 27 patients, therefore 803 out of 830 patients (96.7%) constituted the analysis set for the study \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOne-year Clinical Outcome.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe incidence of MACE was observed in 27 patients (3.4%), with all-cause death occurring in 21 cases (2.6%) and MI occurring in 6 cases (0.7%). TVR occurred in 35 patients (4.4%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBaseline Demographic and Clinical Characteristics.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean age was 61\u0026thinsp;\u0026plusmn;\u0026thinsp;11years and 701 patients were male (87.3%). Patients in the MACE group had a significantly lower body mass index (BMI) (23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 vs 25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047), as well as a lower frequency of PCI history (7.4% vs 32.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) and aspirin usage at discharge (70.4% vs 95.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than those in the no-MACE group. However, they had a higher level of BNP [989 (214,3133) vs 312 (114,951), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005], and a greater prevalence of LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% (37.0% vs 15.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). In the TVR group, patients had a significantly higher proportion of previous PCI (60.0% vs 30.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a lower rate of LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% (2.9% vs 16.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028), and were less likely to clopidogrel usage at discharge (11.4% vs 28.8%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Demographic and Clinical Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003ePrimary Endpoint\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eSecondary Endpoint\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enon-MACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;776)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003enon-TVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;768)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e59\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e701(87.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e678(87.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(85.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e670(87.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e31(88.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.157\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e297(37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e290(37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e285(37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e474(59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e457(58.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(63.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.672\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e451(58.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23(65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.411\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e279(34.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e272(35.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e267(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.953\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e479(59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e463(59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e457(59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22(62.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious MI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e320(39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e308(39.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.620\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e303(39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17(48.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.281\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Kidney Insufficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24(3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeripheral vascular disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious PCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e253(31.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e251(32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e232(30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21(60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious CABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28(3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine, \u0026micro;mol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.957\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e84\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL-C, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.679\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epro-BNP, pg/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318(116,1001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e312(114,951)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e989(214,3133)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e327(121,1017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e157(66,793)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epro-BNP grades\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;221pg/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e324(40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e317(40.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e304(39.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20(57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e221\u0026sim;459pg/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138(17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134(17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e459\u0026sim;1006pg/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142(17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e139(17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e136(17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;1006pg/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e199(24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e186(24.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e193(25.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF\u0026thinsp;\u0026lt;\u0026thinsp;40%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131(16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121(15.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e130(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedication at discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAspirin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e757(94.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e738(95.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e725(94.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e32(91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.445\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClopidogrel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e225(28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e218(28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.805\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e221(28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTicagrelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e576(71.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e557(71.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e546(71.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30(85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEI/ARB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e657(81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e634(81.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(85.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e631(82.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eβ-blockers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e730(90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e704(90.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26(96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e700(91.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30(85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e794(98.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e767(98.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e760(99.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e34(97.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eValues are mean \u0026plusmn; SD, median (interquartile range), or n (%).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eACEI/ARB\u0026thinsp;=\u0026thinsp;angiotensin-Converting Enzyme Inhibitors/ Angiotensin II Receptor Blockers; BMI\u0026thinsp;=\u0026thinsp;Body Mass Index; BNP\u0026thinsp;=\u0026thinsp;Brain Natriuretic Peptide; CABG\u0026thinsp;=\u0026thinsp;Coronary Artery Bypass Grafting; LDL-C\u0026thinsp;=\u0026thinsp;Low-Density Lipoprotein Cholesterol; LVEF\u0026thinsp;=\u0026thinsp;Left Ventricular Ejection Fraction; MI\u0026thinsp;=\u0026thinsp;Myocardial Infarction; PCI\u0026thinsp;=\u0026thinsp;Percutaneous Coronary Intervention.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBaseline Angiographic Characteristics.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNearly half of the patients (44.6%) presented with triple vessel disease, while one-fifth (18.3%) had left main trunk lesion. All patients got a high median pre-procedure SYNTAX score [29 (21,37) points] as well as a high J-CTO score (2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2) in target lesions. In the MACE group, the preoperative Syntax score was significantly higher [37(24,50) vs 29(21,37), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011], along with a greater proportion of left main lesions (37.0% vs 17.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019) and target lesion calcification (59.3% vs 36.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), compared to the non-MACE group. In the TVR group, patients had a higher rate of blunt stump (85.7% vs 69.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) and proximal cap ambiguity (60.0% vs 32.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) than in no TVR group. The proportion of LAD CTO was numerically lower in the no-TVR group (22.9% vs 37.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.072), but no statistical difference was detected (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Angiographic Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003ePrimary Endpoint\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eSecondary Endpoint\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enon-MACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;776)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003enon-TVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;768)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of diseased vessels\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle VD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68(8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65(8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDouble VD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e230(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e224(28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e218(28.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriple VD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e358(44.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e348(44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e345(44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13(37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.365\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLMCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e147(18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137(17.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e140(18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.791\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-procedure SYNTAX score SYNTAXscore(Q\u003csub\u003eL\u003c/sub\u003e,Q\u003csub\u003eU\u003c/sub\u003e)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(21,37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(21,37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(24,50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29(21,38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(17,33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-procedure SYNTAX\u0026ge;37 score \u0026ge;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e201(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188(24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e196(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of CTO vessels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.586\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCTO Target vessel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLMCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e299(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e290(37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.670\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e291(37.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8(22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74(9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73(9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69(9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.362\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e424(52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e407(52.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(63.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e402(52.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22(62.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn-stent occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63(8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOstial lesion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82(10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77(9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e77(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlunt stump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e560(69.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e540(69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(74.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e530(69.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30(85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProximal cap ambiguity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e271(33.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e264(34.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e250(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21(60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalcification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e299(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e283(36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e287(37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.712\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTortuosity\u0026thinsp;\u0026gt;\u0026thinsp;45\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e579(72.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e560(72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.838\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e550(71.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29(82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ereference vessel diameter, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.986\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion length, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion length\u0026thinsp;\u0026ge;\u0026thinsp;20 mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e552(68.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e534(68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e526(68.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of interventional collaterals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e188(23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179(23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e177(23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.252\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiseased distal landing zone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e337(42.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e328(42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e318(41.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(54.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReattempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121(15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117(15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e114(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.404\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJ-CTO score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJ-CTO score \u0026ge;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e470(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e454(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.938\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e445(57.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25(71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.113\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eValues are mean \u0026plusmn; SD, median (interquartile range), or n (%).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eCTO\u0026thinsp;=\u0026thinsp;Chronic Total Occlusion; CX\u0026thinsp;=\u0026thinsp;Circumflex artery; J-CTO\u0026thinsp;=\u0026thinsp;Japanese Multicenter CTO Registry; LAD\u0026thinsp;=\u0026thinsp;Left Anterior Descending Artery; LMCA\u0026thinsp;=\u0026thinsp;Left Main Coronary Artery; RCA\u0026thinsp;=\u0026thinsp;Right Coronary Artery; SYNTAX\u0026thinsp;=\u0026thinsp;Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery; VD\u0026thinsp;=\u0026thinsp;Vessel Disease.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure Characteristics and Outcomes.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 1010 CTO PCIs, 950 technique success (94.1%) were achieved, with 848 (95.2%) in the index PCI (n\u0026thinsp;=\u0026thinsp;891) and 102 (85.7%) in the non-index PCI (n\u0026thinsp;=\u0026thinsp;119), which took a higher portion of LCX-CTO as the target lesion (46.2% vs 9.8%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a lower inch in the diameter of target vessel [2.75(2.50, 3.00)mm vs 3.00(2.75, 3.25)mm, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] than the former.\u003c/p\u003e\u003cp\u003eFor the index procedure patients (n\u0026thinsp;=\u0026thinsp;891), 3 cases (0.3%) died respectively from stent thrombosis, cardiac tamponade, and acute myocardial infarction as the main cause of admission. The non-fatal in-hospital complication includes 6 periprocedural myocardial infarctions (0.8%), 2 emergency TVRs (0.2%) (one of whom was referred for CABG), 11 major bleeding (1.2%) (hemopericardium, approach hematoma, and gastrointestinal bleeding), 10 coronary perforations (1.1%) (necessitating the use of pericardiocentesis, covered stents, coils, and thrombin), 18 peripheral vascular complications (2.0%) (mainly resulted from an access-related vascular injury like pseudoaneurysm, arteriovenous fistula, dissection, perforation, pseudoaneurysm, and hematoma), and 2 renal impairments (0.2%).\u003c/p\u003e\u003cp\u003eAs in the analysis set (n\u0026thinsp;=\u0026thinsp;803), more than one-half of the procedures (n\u0026thinsp;=\u0026thinsp;518, 64.5%) succeeded with the AW strategy, 210 of which (26.2%) with Retrograde, the remaining 75 ones (9.3%)with ADR. In the MACE group, the residual Syntax score [10(5,22) vs 7(3,12), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012], circulation support (14.8% vs 4.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), as well as the occurrence of hospital complications (14.8% vs 4.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031), were higher than those in the non-MACE group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProcedure Characteristics and Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003ePrimary Endpoint\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eSecondary Endpoint\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enon-MACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;776)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMACE\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003enon-TVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;768)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTVR\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuccessful crossing strategy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e518(64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e499(64.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e503(65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRretro\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e210(26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e204(26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e196(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14(40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75(9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73(9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69(9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(17.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDART\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219(27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e211(27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e204(26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGMT, min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(10,60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(10,60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(10,67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.635\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29(10,60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60(20,107)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGMT grades\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e305(38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e296(38.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e297(38.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8(22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026sim;80min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e362(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e350(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e350(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;80min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136(16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130(16.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e121(15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStent implantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e743(92.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e717(92.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26(96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.714\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e714(93.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29(82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of stents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.558\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal stent length, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83\u0026thinsp;\u0026plusmn;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e85\u0026thinsp;\u0026plusmn;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContrast volume, ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e357\u0026thinsp;\u0026plusmn;\u0026thinsp;124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e357\u0026thinsp;\u0026plusmn;\u0026thinsp;124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e353\u0026thinsp;\u0026plusmn;\u0026thinsp;121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.908\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e354\u0026thinsp;\u0026plusmn;\u0026thinsp;123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e409\u0026thinsp;\u0026plusmn;\u0026thinsp;134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidual SYNTAX score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(3,12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(3,12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(5,22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7(3,12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(2,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidual SYNTAX score \u0026ge;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e216(26.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203(26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e211(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanical Circulatory Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn-hospital complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37(4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36(4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eValue are mean \u0026plusmn; SD, median (interquartile range), or n (%).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAW\u0026thinsp;=\u0026thinsp;Antegrade Wiring; ADR\u0026thinsp;=\u0026thinsp;Antegrade Dissection and Re-entry; DART\u0026thinsp;=\u0026thinsp;Dissection and Re-entry techniques; GMT\u0026thinsp;=\u0026thinsp;Guidewire Manipulation Time; Retro\u0026thinsp;=\u0026thinsp;Retrograde; SYNTAX\u0026thinsp;=\u0026thinsp;Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCompared with the non-TVR group, the TVR group had lower rates of AW strategy success (42.9% vs 65.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) and stent implantation (82.9% vs 93.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), while higher DART application rate (42.9% vs 26.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034), longer GMT [60 (20,107) vs 29 (10,60), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001]), and more contrast media (409\u0026thinsp;\u0026plusmn;\u0026thinsp;134 vs 354\u0026thinsp;\u0026plusmn;\u0026thinsp;123, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAnalysis of Predictive Factors for One-year MACE\u003c/h3\u003e\n\u003cp\u003eThe above clinical baseline, coronary angiography features, and intraoperative outcome data were analyzed using univariate analyses. The results suggested that BMS, history of PCI, BNP, LVEF, aspirin usage, left main lesions, number of CTOs, calcification, MCS usage, hospital complications, preoperative Syntax score, and residual Syntax score were variables that might affect MACE.\u003c/p\u003e\u003cp\u003eMultivariate analysis showed that PCI history, LVEF, aspirin usage, and residual Syntax score were correlated with the occurrence of MACE. Among these variables, LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% (HR\u0026thinsp;=\u0026thinsp;2.837, 95%CI:1.295\u0026ndash;6.215, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) and residual Syntax score\u0026thinsp;\u0026ge;\u0026thinsp;12 (HR\u0026thinsp;=\u0026thinsp;2.585, 95%CI:1.213\u0026ndash;5.509, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014) were identified as independent risk factors, while PCI history (HR\u0026thinsp;=\u0026thinsp;0.153, 95%CI:0.036\u0026ndash;0.649, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011) and aspirin usage (HR\u0026thinsp;=\u0026thinsp;0.129, 95%CI:0.056\u0026ndash;0.295, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001)were found to be protective factors (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). The Kaplan\u0026ndash;Meier plot showed a gradual decline of the MACE-free survival rate over time in both groups after 1-year post-PCI, but a more pronounced decrease was observed in the EF\u0026lt;40% group. The disparity between the two groups demonstrated statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Consequently, an EF\u0026thinsp;\u0026ge;\u0026thinsp;40% conferred a protective effect on patients with CTO compared to those with an EF\u0026thinsp;\u0026lt;\u0026thinsp;40%. Consistently, residual SYNTAX score\u0026thinsp;\u0026ge;\u0026thinsp;12 brought more risk to the patient within a year after discharge (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011). (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of Predictive Factors of One-year TVR.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSimilarly, univariate analysis for TVR predictors suggests that PCI history, usage of clopidogrel, blunt stump, proximal cap ambiguity, antegrade opening, DART application, GMT, contrast dosage, and DES implantation are significant variables affecting TVR. Additionally, LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% and pre-reduced CTO potentially took an important role. Multivariate analysis showed that PCI history, LAD CTO, proximal cap ambiguity, GMT and stent implantation were related to the occurrence of TVR, and PCI history (HR\u0026thinsp;=\u0026thinsp;2.842, 95%CI: 1.440\u0026ndash;5.612, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), proximal cap ambiguity(HR\u0026thinsp;=\u0026thinsp;2.854, 95%CI:1.353\u0026ndash;6.019, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) and GMT (HR\u0026thinsp;=\u0026thinsp;1.945, 95%CI:1.190\u0026ndash;3.178, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) were independent risk factors, while LAD CTO (HR\u0026thinsp;=\u0026thinsp;0.438, 95%CI:0.195\u0026ndash;0.982, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045) and stent implantation (HR\u0026thinsp;=\u0026thinsp;0.184, 95% CI:0.069\u0026ndash;0.489, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) were protective factors (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The Kaplan-Meier plot demonstrated the 1-year TVR-free survival rate in the non-ambiguity group was higher than that in the ambiguity group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). The impact of GMT on TVR was further confirmed and the results indicated no statistical difference between the \u0026lt;\u0026thinsp;20min group and the 20-80min group, while significant differences were observed between the \u0026ge;\u0026thinsp;80min group and both the \u0026lt;\u0026thinsp;20min group and the 20-80min group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, several studies have reported a significantly higher success rate of CTO PCI, making it an increasingly accepted treatment for patients with CTO\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. However, limited evidence was found to identify prognostic factors, particularly those related to lesion characteristics and procedure outcomes, that would impact the one-year outcome of patients successfully treated with contemporary CTO PCI. Therefore, we conducted an analysis to identify predictive factors that may influence the one-year outcomes. In this study, the patients had a high proportion of co-morbidities, multivessel disease, and complex CTO lesions. Patients in the MACE group showed a lower BMI, implying the obesity paradox in patients with CTO that higher BMI was associated with better long-term outcome\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Patients with lower DM rates had numerically higher MACEs mainly because of selection bias and short-term follow-up. Most procedures succeeded with the AW strategy, while ADR was utilized in only a minority of cases. Overall procedures were performed with a shorter guidewire manipulation time compared to the report by Tanaka H\u003csup\u003e19\u003c/sup\u003e from the Japanese CTO-PCI expert registry, and with a lower rate of stent implantation compared to the data by Maeremans J \u003csup\u003e20\u003c/sup\u003e from the RECHARGE registry which mainly due to smaller reference diameters. Most of these patients underwent procedures with the utilization of DCBs instead. The incidence of MACE and TVR in the follow-up results was parallelly low, similar to previously published data\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccording to the multivariable analysis, strategy and DART performed during the procedure were not associated with the endpoint of MACE. Instead, previous PCI, LVEF, aspirin usage at discharge and residual SYNTAX score played a significant role. Patients with a history of PCI had significantly lower pre-procedure SYNTAX scores compared to those without previous PCI history, indicating a prior aggressive and completely revascularization of non-target lesions for the former ones, which contributes to more effective myocardial protection against ischemia following after index CTO PCI. This study found that all-cause mortality and MACEs were higher in patients with LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% compared to those with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;40% after successful CTO PCI. What needs to be remind is that reduced LV function was associated with a 3-fold increased risk of mortality in patients with CTO lesions undergoing PCI, and patients with reduced LV function also could deserve clear benefits of all-cause mortality reduction after successful CTO PCI than those with procedure failure\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. This is important for the relatively young population, especially with LV dysfunction. Furthermore, six patients who were not prescribed aspirin at discharge occurred death. These patients were categorized based on their previous gastrointestinal bleeding (2 cases), age\u0026thinsp;\u0026ge;\u0026thinsp;75 years (1 case), severe anemia resulting in massive blood loss during the procedure (1 case), and use of oral anticoagulation (2 cases). Although death causes for these patients couldn\u0026rsquo;t be determined, it was an inevitable problem that cases in the MACE group had a higher proportion of not taking aspirin upon discharge. Therefore, it is important to balance antiplatelet therapy with the risk of bleeding for a special population after CTO PCI. CTO lesions are believed to be a characteristic of the end-stage of coronary heart disease, which often is diagnosed as multivessel lesions. Our study results showed that incomplete revascularization was significantly associated with a higher incidence of MACEs following one year follow-up, which aligns with previous findings\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Therefore, the lower the residual SYNTAX score in CTO PCI, the greater the reduction in MACE incidence.\u003c/p\u003e\u003cp\u003eMultivariable analysis for TVR revealed that the occurrence of TVR was correlated with a history of PCI, LAD-CTO, proximal cap ambiguity, GMT, and implanted stents. In contrast to the MACE case, a history of PCI was a risk factor for TVR. Previous PCI means an advanced coronary disease development or a proactive intervention. For a CTO patient, a previous proactive intervention brings more benefits in alleviating myocardial ischemia, resulting in the reduction of MACE after successful CTO PCI. Meanwhile, patients with advanced coronary disease development are more likely to get an in-stent restenosis after CTO PCI. Patients with a LAD-CTO are prone to having a lower rate of TVR due to less anatomical tortuosity and less frequent DART employed. But, the impact of DART on TVR remains controversial\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Several reports have suggested that the use of DART is not correlated with an increase in TVR. Although the frequency of TVR in the DART group was not significantly higher than that in the wire-based group, there was a noticeable numerical increase, suggesting that DART may potentially increase the risk of TVR.\u003c/p\u003e\u003cp\u003eProximal cap ambiguity is universally recognized as an important adverse characteristic of CTO lesion, for which the retrograde technique is recommended as the primary strategy given the presence of interventional collateral\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. For interventional collateral unusable, ADR may be the only option\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In this study, proximal cap ambiguity significantly increased TVR, mainly because of DART, lesion length, and time of guidewire tracking extraplaque, as we found procedures with a proximal cap ambiguity had longer lesion lengths, performed more DART, and consumed more GMT. To some extent, longer subintimal tracking and more devices applied in the CTO segment tend to result in a wider subintimal space, which implies more loss of endothelial cells and desmoplasia, leading to restenosis\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The GMT practically indicates the complexity of CTO lesions. The longer GMT consumed, corresponds to the higher the J-CTO score lesion, and more complex techniques and invasive devices are used, and more complications may occur\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. All these characteristics potentially contribute to a wide subintimal space, injuring the vascular structure, and connective tissue hyperplasia, which may generate more TVR\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In this study, pure angioplasty without stent implantation was performed in some cases, however, these cases were more prone to suffer restenosis. Although DCB angioplasty was applied in a small population, no protective effect against TVR similar to stenting was observed. This conclusively prioritizes stenting in the CTO-PCI procedure. This conclusively prioritizes stenting during the CTO-PCI procedure.\u003c/p\u003e\u003cp\u003eIn comparison to the reports from the United States and Europe, our study population was younger and had a lower proportion of female patients, while similar technique success and in-hospital complications were achieved between males and females, and females were significantly older and had longer lesion length\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. The predictive factors of one-year outcomes were systematically analyzed, involving angiographic characteristics and procedural outcomes. Interestingly, few reports have proposed contradictory effects that a history of PCI took on MACE and TVR, as well as an increased MACE due to discontinuation of aspirin for the high bleeding risk population after CTO recanalization. Proximal cap ambiguity and prolonged GMT was rarely reported as contributing to an increase in TVR. Further research is required to investigate how these factors act mechanically.\u003c/p\u003e\n\u003ch3\u003eStudy Limitations\u003c/h3\u003e\n\u003cp\u003eThis is a prospective single-center observational study, which is limited by its inherent susceptibility to selection bias. Each CTO PCI procedure was performed by an experienced interventional cardiologist, and guidewire selection, approach, and crossing strategies were left to the discretion of the operator performing the procedure. Therefore, caution should be exercised when applying these results to clinical practice. Also, there is not a committee for adverse event adjudication. However, considering the purpose of this study, coronary angiographic characteristics and procedure outcomes from a single operator offer consistent data scales, reduce operator bias, and enhance the stability of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePatients deserved favorable one-year outcomes with a low incidence of MACE and TVR following successful contemporary CTO PCI. For this specific population, LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% and residual SYNTAX score\u0026thinsp;\u0026ge;\u0026thinsp;12 were independent risk factors on MACE, while prior PCI and aspirin usage at discharge were protective factors. Prior PCI, proximal cap ambiguity and GMT were independent risk factors on TVR, while LAD-CTO presence and stent implantation were protective factors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.HK., L.CX for study design. L.J., Ch.GR., W.H., C.Y., Ch. YH., L. XL for data collection; L.J., Ch. GR for data analysis; G.HK. L.CX for supervision; L. J for writing of the original version; G.HK and L. CX for review and revision; All authors reviewed and approved the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Shaanxi Province Key Research and Development Project (No: 2024GX -YBXM-136).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to the corresponding author\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the Department of Cardiology, the First Affiliated Hospital of Air Force Military Medical University, Xi\u0026rsquo;an 710032, China.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGalassi AR et al. Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery. \u003cem\u003eEuroIntervention\u003c/em\u003e 20, e174-e184. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4244/eij-d-23-00749\u003c/span\u003e\u003cspan address=\"10.4244/eij-d-23-00749\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrilakis ES, et al. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation. 2019;140:420\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIRCULATIONAHA.119.039797\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.119.039797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhn JH, et al. Impact of Chronic Total Coronary Occlusion Location on Long-term Survival After Percutaneous Coronary Intervention. Rev Esp Cardiol (Engl Ed). 2019;72:717\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.rec.2018.07.011\u003c/span\u003e\u003cspan address=\"10.1016/j.rec.2018.07.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoebers LP, et al. Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol. 2015;187:90\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijcard.2015.03.164\u003c/span\u003e\u003cspan address=\"10.1016/j.ijcard.2015.03.164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMegaly M, et al. Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention. Cardiovasc intervention Ther. 2022;37:483\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12928-021-00819-x\u003c/span\u003e\u003cspan address=\"10.1007/s12928-021-00819-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu EB, et al. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78:840\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2021.05.055\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2021.05.055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVadal\u0026agrave; G et al. Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry. \u003cem\u003eEuroIntervention\u003c/em\u003e 20, e185-e197. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4244/eij-d-23-00490\u003c/span\u003e\u003cspan address=\"10.4244/eij-d-23-00490\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShoaib A, et al. Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length. Catheter Cardiovasc Interv. 2022;99:234\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.30015\u003c/span\u003e\u003cspan address=\"10.1002/ccd.30015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrilakis ES, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5:367\u0026ndash;79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcin.2012.02.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jcin.2012.02.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarding SA, et al. A New Algorithm for Crossing Chronic Total Occlusions From the Asia Pacific Chronic Total Occlusion Club. JACC Cardiovasc Interv. 2017;10:2135\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcin.2017.06.071\u003c/span\u003e\u003cspan address=\"10.1016/j.jcin.2017.06.071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorino Y, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcin.2010.09.024\u003c/span\u003e\u003cspan address=\"10.1016/j.jcin.2010.09.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim YJ, et al. Immediate complete revascularization showed better outcome in out-of-hospital cardiac arrest survivors with left main or triple-vessel coronary diseases. Sci Rep. 2022;12(1):4354. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-022-08383-x\u003c/span\u003e\u003cspan address=\"10.1038/s41598-022-08383-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYbarra LF, et al. Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations. Circulation. 2021;143:479\u0026ndash;500. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/circulationaha.120.046754\u003c/span\u003e\u003cspan address=\"10.1161/circulationaha.120.046754\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThygesen K, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40:237\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/eurheartj/ehy462\u003c/span\u003e\u003cspan address=\"10.1093/eurheartj/ehy462\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e263\u0026ndash;421. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2021.12.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2021.12.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYbarra LF, Rinfret S. Why and How Should We Treat Chronic Total Occlusion? Evolution of State-of-the-Art Methods and Future Directions. Can J Cardiol. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cjca.2020.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.cjca.2020.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTsai CT, et al. Obesity paradox in patients with chronic total occlusion of coronary artery. Eur J Clin Invest. 2022;52:e13698. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/eci.13698\u003c/span\u003e\u003cspan address=\"10.1111/eci.13698\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWon KB, et al. Comparison of long-term mortality according to obesity in patients with successful percutaneous chronic total occlusion interventions using drug-eluting stents. Catheter Cardiovasc Interv. 2018;91:710\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.27110\u003c/span\u003e\u003cspan address=\"10.1002/ccd.27110\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTanaka H, et al. A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion. J Am Coll Cardiol. 2019;74:2392\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2019.08.1049\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2019.08.1049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaeremans J, et al. The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry. J Am Coll Cardiol. 2016;68:1958\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2016.08.034\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2016.08.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilson WM, et al. One-year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re-entry techniques. Catheter Cardiovasc Interv. 2017;90:703\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.26980\u003c/span\u003e\u003cspan address=\"10.1002/ccd.26980\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGalassi AR, et al. Wire-based antegrade dissection re-entry technique for coronary chronic total occlusions percutaneous revascularization: Experience from the ERCTO Registry. Catheter Cardiovasc Interv. 2023;102:864\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.30827\u003c/span\u003e\u003cspan address=\"10.1002/ccd.30827\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eToma A, et al. Survival after percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol. 2016;105:921\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00392-016-1000-2\u003c/span\u003e\u003cspan address=\"10.1007/s00392-016-1000-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAzzalini L, et al. Impact of Incomplete Revascularization on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol. 2018;121:1138\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjcard.2018.01.033\u003c/span\u003e\u003cspan address=\"10.1016/j.amjcard.2018.01.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbouzaki NA, Exaire JE, Guzm\u0026aacute;n LA. Role of Percutaneous Chronic Total Occlusion Interventions in Patients with Ischemic Cardiomyopathy and Reduced Left Ventricular Ejection Fraction. Curr Cardiol Rep. 2018;20:124. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11886-018-1066-8\u003c/span\u003e\u003cspan address=\"10.1007/s11886-018-1066-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaeremans J, et al. One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: A Subanalysis of the Multicenter RECHARGE Registry. J Invasive Cardiol. 2018;30:62\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark Y, et al. Intravascular ultrasound guided recanalization of stumpless chronic total occlusion. Int J Cardiol. 2011;148:174\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijcard.2009.10.052\u003c/span\u003e\u003cspan address=\"10.1016/j.ijcard.2009.10.052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaratasakis A, et al. Impact of Proximal Cap Ambiguity on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter US Registry. J Invasive Cardiol. 2016;28:391\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMegaly M, et al. Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv. 2022;100:1021\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.30403\u003c/span\u003e\u003cspan address=\"10.1002/ccd.30403\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiura K, et al. Impact of Timing and Treatment Strategy on Coronary Perforation During Percutaneous Coronary Intervention for Chronic Total Occlusion. Am J Cardiol. 2022;172:26\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjcard.2022.02.019\u003c/span\u003e\u003cspan address=\"10.1016/j.amjcard.2022.02.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAvran A, et al. Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study. Catheter Cardiovasc Interv. 2023;101:918\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ccd.30616\u003c/span\u003e\u003cspan address=\"10.1002/ccd.30616\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTajti P, et al. The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry. JACC Cardiovasc Interv. 2018;11:1325\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcin.2018.02.036\u003c/span\u003e\u003cspan address=\"10.1016/j.jcin.2018.02.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic Total Occlusion (CTO), Percutaneous Coronary Intervention (PCI), Major Adverse Cardiovascular Events (MACE), Target Vessel Revascularization (TVR)","lastPublishedDoi":"10.21203/rs.3.rs-7582516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7582516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWe aimed to explore the predictive factors and one-year clinical outcomes following successful contemporary CTO-PCI.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eConsecutive patients from January 2018 to December 2020 were enrolled. The primary endpoint was major adverse cardiovascular events (MACE) which included all-cause death and myocardial infarction, while target vessel revascularization (TVR) was defined as the secondary endpoint, all of which were measured at 12 months.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 830 patients were treated by successful CTO PCI, and 96.7% of these cases were available with one-year follow-up data (n\u0026thinsp;=\u0026thinsp;803). The incidence of MACE was observed in 27 patients (3.4%), with all-cause death occurring in 21 cases (2.6%) and myocardial infarction in 6 cases (0.7%). TVR occurred in 35 patients (4.4%). The multivariate predictive factor analysis for MACE indicated that LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40% (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007) and residual SYNTAX score\u0026thinsp;\u0026ge;\u0026thinsp;12 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was identified as independent risk factors for MACE. While prior PCI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017) and aspirin usage (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were protective factors. Parallelly, prior PCI and proximal cap ambiguity (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and guide-wire manipulation time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) were independent risk factors for TVR, while LAD-CTO presence (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045) and stent implantation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) were protective factors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePatients deserved favorable outcomes and a low incidence of adverse events after one year following successful contemporary CTO PCI.\u003c/p\u003e","manuscriptTitle":"Predictive factors and clinical outcomes following successful contemporary percutaneous coronary interventions for chronic total occlusions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 07:05:26","doi":"10.21203/rs.3.rs-7582516/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c52ecff3-8ece-4b0e-b9d0-cf0ffeab8fd5","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T08:54:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 07:05:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7582516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7582516","identity":"rs-7582516","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}