Outcomes of retrograde chronic total occlusion percutaneous coronary intervention: A report from the OPEN-CTO registry

Sanjog Kalra, Darshan Doshi, James Sapontis, Ioanna Kosmidou, Ajay J. Kirtane, Jeffrey W. Moses, Robert F. Riley, Philip Jones, William J. Nicholson, Adam C. Salisbury, William L. Lombardi, James M. McCabe, Ashish Pershad, Taishi Hirai, Emad Hakemi, Juan J. Russo, Megha Prasad, Yousif Ahmad, Raja Hatem, Fotis GkargkoulasJohn A. Spertus, R. Michael Wyman, Farouc Jaffer, Anthony Spaedy, Stephen Cook, Steven P. Marso, Karen Nugent, Robert Federici, Robert W. Yeh, Martin B. Leon, Gregg W. Stone, Ziad A. Ali, Manish A. Parikh, Akiko Maehara, David J. Cohen, Candido Batres, J. Aaron Grantham, Dimitri Karmpaliotis

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives: We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI). Background: Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown. Methods: Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion). Results: Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p <.001) and technical success lower (82.4 vs. 94.2%; p <.001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p =.003), but not at 1-year (4.9 vs. 3.3%; p =.29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p <.001) and at 1-year (19.5 vs. 13.9%; p =.03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p =.58). Conclusions: In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.

Original languageEnglish (US)
Pages (from-to)1162-1173
Number of pages12
JournalCatheterization and Cardiovascular Interventions
Issue number6
StatePublished - May 1 2021
Externally publishedYes


  • chronic total occlusion
  • percutaneous coronary intervention
  • retrograde

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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