Reply: Due to the lack of significant mortality benefits along with high procedural complication rates, percutaneous coronary intervention of chronic total occlusions should be discouraged

The author of the letter expresses concerns about percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO)1. The author cites a “very high” complication rate in studies that compared successful and unsuccessful CTO PCI procedures. Failed procedures are associated with higher complication rates than successful procedures, certainly, and indeed the randomised EuroCTO study confirms this observation. We found a significant increase in complication rates after failed procedures, but successful procedures resulted in outcomes that were better than with medical management2.

The author comments that in US community hospitals, complication rates for CTO PCI are higher than for non-CTO lesions3. This is not surprising. CTO PCI is a highly complex procedure and, when undertaken by non-specialist operators, has a lower procedural success rate and a higher complication rate. There is a clear relationship between volume and outcome4. CTO PCI is not a routine procedure to be performed by any operator in every institution. It requires training, experience, and familiarity with dedicated equipment and techniques. Indeed the EuroCTO club has emphasised the need for dedicated CTO PCI...