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Peer-reviewedCC BY-NC-SAPostepy w kardiologii interwencyjnej = Advances in interventional cardiology

Association of older age with outcomes of retrograde chronic total occlusion percutaneous coronary interventions

  • Sefa Sural1
  • Vedat Aslan1
  • Abdullah Yıldırım2
  • Mahmut Uluganyan3
  • Gokhan Avci1
  • Baris Duzel4
  • Emmanouil S. Brilakis5
  • Sevket Gorgulu6
6 affiliations
  1. 1Toros University, Mersin, Türkiye
  2. 2Department of Cardiology, Adana City Training and Research Hospital, Adana, Türkiye
  3. 3Department of Cardiology, Bezmialem Vakif University, Istanbul, Türkiye
  4. 4Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Türkiye
  5. 5Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, USA
  6. 6Cardiology Department, School of Medicine, Biruni University, Istanbul, Türkiye
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Abstract

Introduction: The association of older age with collateral characteristics, retrograde crossing success, and procedural outcomes in chronic total occlusions-percutaneous coronary intervention (CTO-PCI) remains poorly understood.

Aim: To investigate the association between older age and collateral characteristics, retrograde crossing success, and procedural outcomes.

Material and methods: Among 2,077 CTO-PCI procedures performed between January 2019 and April 2026 at four experienced CTO centers, 564 procedures with complete datasets and at least one attempted retrograde approach were included. Procedures were stratified according to age (< 65 vs. ≥ 65 years). Collateral assessment, collateral crossing, retrograde lesion crossing, and procedural outcomes were analyzed. Inverse probability of treatment weighting (IPTW) and multivariable logistic regression analyses were performed to identify predictors of successful retrograde crossing.

Results: A total of 201 of 564 procedures (35.6%) were performed in patients aged ≥ 65 years. Elderly patients were more likely to have moderate/severe calcification (58.7% vs. 43.3%, p < 0.001), and had higher J-CTO scores (3.3 ±1.0 vs. 3.0 ±1.0, p = 0.004) and more difficult J-channel collateral anatomy (38.8% vs. 30.3%, p = 0.020). In the unadjusted analysis, successful retrograde CTO crossing was significantly lower in elderly patients (61.7% vs. 73.0%, p = 0.007). Technical success (74.6% vs. 83.7%, p = 0.009) and procedural success (73.1% vs. 82.1%, p = 0.013) were also lower in elderly patients. After IPTW adjustment, age ≥ 65 years remained independently associated with lower odds of successful retrograde crossing (OR = 0.64, 95% CI: 0.41–0.99; p = 0.039). Continuous age analysis demonstrated a progressive decrease in retrograde crossing success with increasing age (OR/year = 0.969, p = 0.001). Vascular access-site complications were more frequent in elderly patients (4.5% vs. 1.7%, p = 0.046).

Conclusions: Older age remained independently associated with lower retrograde CTO crossing success after IPTW adjustment.

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Cite

BibTeXRIS
BibTeX
@article{sural2026association,
  title = {{Association of older age with outcomes of retrograde chronic total occlusion percutaneous coronary interventions}},
  author = {Sefa Sural and Vedat Aslan and Abdullah Yıldırım and Mahmut Uluganyan and Gokhan Avci and Baris Duzel and Emmanouil S. Brilakis and Sevket Gorgulu},
  journal = {Postepy w kardiologii interwencyjnej = Advances in interventional cardiology},
  year = {2026},
  month = sep,
  doi = {10.5114/aic.2026.164735},
  url = {https://europepmc.org/article/PMC/PMC13721061},
  note = {CC BY-NC-SA},
}
RIS
TY  - JOUR
TI  - Association of older age with outcomes of retrograde chronic total occlusion percutaneous coronary interventions
AU  - Sefa Sural
AU  - Vedat Aslan
AU  - Abdullah Yıldırım
AU  - Mahmut Uluganyan
AU  - Gokhan Avci
AU  - Baris Duzel
AU  - Emmanouil S. Brilakis
AU  - Sevket Gorgulu
PY  - 2026
DA  - 2026/09/01
JO  - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology
DO  - 10.5114/aic.2026.164735
UR  - https://europepmc.org/article/PMC/PMC13721061
AB  - Introduction: The association of older age with collateral characteristics, retrograde crossing success, and procedural outcomes in chronic total occlusions-percutaneous coronary intervention (CTO-PCI) remains poorly understood.  Aim: To investigate the association between older age and collateral characteristics, retrograde crossing success, and procedural outcomes.  Material and methods: Among 2,077 CTO-PCI procedures performed between January 2019 and April 2026 at four experienced CTO centers, 564 procedures with complete datasets and at least one attempted retrograde approach were included. Procedures were stratified according to age (< 65 vs. ≥ 65 years). Collateral assessment, collateral crossing, retrograde lesion crossing, and procedural outcomes were analyzed. Inverse probability of treatment weighting (IPTW) and multivariable logistic regression analyses were performed to identify predictors of successful retrograde crossing.  Results: A total of 201 of 564 procedures (35.6%) were performed in patients aged ≥ 65 years. Elderly patients were more likely to have moderate/severe calcification (58.7% vs. 43.3%, p < 0.001), and had higher J-CTO scores (3.3 ±1.0 vs. 3.0 ±1.0, p = 0.004) and more difficult J-channel collateral anatomy (38.8% vs. 30.3%, p = 0.020). In the unadjusted analysis, successful retrograde CTO crossing was significantly lower in elderly patients (61.7% vs. 73.0%, p = 0.007). Technical success (74.6% vs. 83.7%, p = 0.009) and procedural success (73.1% vs. 82.1%, p = 0.013) were also lower in elderly patients. After IPTW adjustment, age ≥ 65 years remained independently associated with lower odds of successful retrograde crossing (OR = 0.64, 95% CI: 0.41–0.99; p = 0.039). Continuous age analysis demonstrated a progressive decrease in retrograde crossing success with increasing age (OR/year = 0.969, p = 0.001). Vascular access-site complications were more frequent in elderly patients (4.5% vs. 1.7%, p = 0.046).  Conclusions: Older age remained independently associated with lower retrograde CTO crossing success after IPTW adjustment.
SN  - 1734-9338
SN  - 1897-4295
ER  -