The Gulf Chronic Total Occlusion Registry: Short- and Long-Term Outcomes Across Management Strategies.

Authors

Amin Daoulah, Mokhtar Abdirahman Kahin, Prashanth Panduranga, Wael Almahmeed, Ibrahim A M Abdulhabeeb, Fahad Alkindi, Amir Lotfi, Shaber Seraj, Ahmed Jamjoom, Amr A Arafat, Omar Kanbr, Adnan Fathey Hussien, Bandar Alamro, Harvey Anthony, Ibrahim Mohammed AlEidan, Gladsy Selva Livingston, Alsayed Ali Almarghany, Abdullah Nabi Aslan, Sharafeldin M S Elamin, Suhaib Al Mashari, Ronney Shantouf, Taha H Noor, Adil Alryami, Hind Alosaimi, Muhammad Asif Khan, Ziad Dahdouh, Mohammed Balghith, Nooraldaem Yousif, Husam A Noor, Ather Sadiq, Abdullah Al Ismaili, Ashraf Al Azzoni, Khalid Tammam, Syed Jamal, Hassan Khan, Muhannad Almubarak, Hani Sulieman Alanati, Youssef Elmahrouk, Tarique Shahzad Chachar, Abdulwali Abohasan, Ahmed A Jouda, Abdulaziz AlGhamdi, Said Al Maashani, Montaser Y Ismail, Abdulrahman Arabi, Abdullah Alquaid, Mohammed Alshehri, Ethan M Ross, Muhammad Nouman Iqbal, Rawan Alsaadi, Ahmed Elmahrouk

Published in

JACC. Advances. Volume 5. Issue 9. Pages 103015. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

Chronic total occlusion (CTO) is associated with increased ischemic burden, heart failure, and mortality. Comparative clinical outcomes associated with medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) remain uncertain.
To compare clinical outcomes associated with medical therapy, PCI, and CABG in patients with CTO.
We analyzed 741 patients with angiographically confirmed CTO enrolled across 7 tertiary centers in 4 Gulf countries between 2021 and 2023. Patients were managed with an initial strategy of medical therapy (n = 151), PCI (n = 441), or CABG (n = 149). The primary in-hospital endpoint was major adverse cardiovascular events. The long-term endpoint was major adverse cardiac and cerebrovascular events-free survival.
Treatment allocation differed substantially by baseline clinical and angiographic risk. Medically managed patients had worse renal function, more severely reduced left ventricular ejection fraction, and more cardiogenic shock despite simpler CTO anatomy CABG patients had more extensive multivessel disease, whereas PCI patients had greater CTO lesion complexity. After adjustment, neither PCI nor CABG differed significantly from medical therapy for in-hospital major adverse cardiovascular events. At a median follow-up of 22 months, adjusted 36-month restricted mean survival time analyses showed no statistically significant difference in major adverse cardiac and cerebrovascular events-free survival between PCI, CABG, and medical therapy. Adjusted Canadian Cardiovascular Society class I at last follow-up was reached in 86.2% of medical therapy, 91.7% of PCI, and 98.0% of CABG patients; the adjusted difference vs medical therapy was significant for CABG (P < 0.001) but not for PCI P = 0.17).
After adjustment, no treatment strategy demonstrated superiority for hard cardiovascular outcomes; revascularization, particularly CABG, was associated with a lower angina burden at follow-up.

PMID:
42561488
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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