Bleeding complications after percutaneous coronary intervention of CTO lesions versus non-CTO lesions: a prospective observational study from the South-East Netherlands Heart Registration (ZON-HR).

Authors

Alexander M Griffioen, Eva C I Woelders, Sanne Janssen, Denise A M Peeters, Mustafa Ilhan, Jasper J P Luijkx, Mohamed M Reda, Patty J C Winkler, Marleen H van Wely, Peter Damman, Wouter S Remkes, Arnoud W J Van't Hof, Robert-Jan M van Geuns, ZON-HR Investigators

Published in

BMJ open. Volume 16. Issue 9. Pages e119900. Sep 28, 2026. Epub Sep 28, 2026.

Abstract

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known for higher adverse event rates compared with non-CTO PCI. Comparative outcomes with respect to bleeding events remain limited.
To evaluate bleeding events in patients undergoing CTO PCI compared with non-CTO PCI and to identify patient and procedural characteristics associated with bleeding events.
Prospective multicentre study of ongoing collected data registered within the South-East Netherlands Heart Registry (Zuid-Oost Nederland Hart Registratie, ZON-HR).
All consecutive patients with coronary artery disease undergoing clinically indicated PCI are included in the ZON-HR since November 2020.
At the time of analyses, the ZON-HR consisted of 8264 included patients with 30-day follow-up between November 2020 and December 2023. A total of 8162 patients were included once in the registry. CTO PCI was performed in 410 (5.0%) patients and non-CTO PCI in 7854 (95.0%) patients. Bleeding events occurred more frequently in patients undergoing CTO PCI compared with non-CTO PCI (9.0% vs 5.4%, p<0.01), driven by a significantly higher rate of access-site bleeding events (7.6% vs 3.2%, p<0.01). After multivariable analysis, CTO was not significantly associated with the occurrence of access-site bleeding events (adjusted HR (aHR) 1.39 (95% CI 0.92 to 2.11)). Access-site bleeding events were associated with female sex (aHR 1.71 (95% CI 1.34 to 2.18)), peripheral artery disease (aHR 1.39 (95% CI 1.02 to 1.89)), oral anticoagulation use (aHR 1.34 (95% CI 1.00 to 1.78)), femoral artery access (aHR 2.90 (95% CI 2.08 to 4.05)) and left main PCI (aHR 1.50 (95% CI 1.04 to 2.14)).
The incidence of bleeding events is higher in patients undergoing CTO PCI and particularly driven by access-site bleeding events. The apparent correlation is attributed to non-modifiable and modifiable patient-related and procedure-related characteristics rather than the CTO PCI itself.
NCT06512493.

PMID:
42805651
Bibliographic data and abstract were imported from PubMed on 29 Sep 2026.

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