Aims: The aim of the study was to assess the long-term outcomes of coronary chronic total occlusion (CTO) lesions after retrograde percutaneous coronary intervention (PCI) in comparison with those after antegrade PCI alone.
Methods and results: A total of 842 consecutive patients (928 CTO lesions) undergoing PCI and subsequent follow-up were classified into two groups: retrograde PCI for at least one CTO (n=302, retrograde group) and antegrade PCI alone (n=540, antegrade group). The total procedural success rate was 89.7%. The retrograde group had significantly higher incidences of periprocedural myocardial infarction and coronary perforation (7.3% vs. 3.7%, p=0.01; 7.9% vs. 4.4%, p=0.04, respectively). Median follow-up duration was 7.7 (interquartile range 5.6-8.7) years. Seven-year relative risk comparing the retrograde and antegrade groups was neutral in all-cause death (adjusted HR [aHR] 1.06, 95% CI: 0.75-1.49; p=0.745), cardiac death (aHR 0.85, 95% CI: 0.47-1.55; p=0.598), coronary artery bypass grafting (aHR 1.62, 95% CI: 0.74-3.54; p=0.229), and non-target vessel revascularisation (aHR 0.96, 95% CI: 0.78-1.17; p=0.663).
Conclusions: Retrograde CTO PCI did not lead to worse long-term outcomes despite increased risk in periprocedural myocardial infarction and coronary perforation.