Contemporary Clinical Practices in Korean Patients With Coronary Chronic Total Occlusion: Results From the K-CTO Nationwide Retrospective Registry

Year: 2026

Type: article

Abstract: BACKGROUND AND OBJECTIVES: Coronary chronic total occlusion (CTO) is among the most challenging forms of coronary artery disease, yet large-scale real-world data remain limited. We aimed to describe contemporary CTO clinical practice and outcomes in South Korea. METHODS: The Korean Chronic Total Occlusion (K-CTO) registry 2.0 is a nationwide retrospective registry including patients diagnosed with CTO between 2003 and 2023 at 34 centers performing percutaneous coronary intervention (PCI), irrespective of CTO-PCI performance. Demographic, clinical, procedural, and outcome data were analyzed. RESULTS: Of 9,316 patients with CTO, 7,267 (78.0%) underwent PCI. The overall procedural success rate was 82.2%. The antegrade approach was used in 87.5% of cases and the retrograde in 12.5%, with procedural success rates of 82.8% and 78.5%, respectively. Intravascular ultrasonography was employed in 37.3%, and drug-eluting stents were implanted in 76.8%. Predictors of PCI attempts included younger age, prior PCI, and stable angina, whereas diabetes mellitus (DM), chronic kidney disease (CKD), prior CABG, and higher Japanese CTO scores were associated with less frequent PCI attempts. In-hospital all-cause mortality was 2.3% and periprocedural myocardial infarction (MI) 4.4%. At a median follow-up of 651 days, 5-year cumulative incidences of major adverse cardiac and cerebrovascular events, major adverse cardiac events, net adverse clinical events, and all-cause mortality were 30.4%, 28.5%, 30.9%, and 14.5%, respectively. CONCLUSIONS: In routine practice across South Korea, most patients with CTO underwent PCI with high success. These descriptive findings should not be interpreted as evidence of improved long-term outcomes. Broader adoption of advanced techniques and device accessibility may further improve results in complex CTO lesions.

Source: Korean Circulation Journal

DOI: 10.4070/kcj.2025.0412

Institutions: Korea University Anam Hospital, Hanyang University Guri Hospital, Hanyang University, Inje University, Inje University Haeundae Paik Hospital, Soonchunhyang University Hospital Bucheon, Yonsei University, Severance Hospital, Yonsei University Health System, Asan Medical Center, University of Ulsan, Korea University Guro Hospital, Hallym University, Hallym University Kangnam Sacred Heart Hospital, Wonkwang University Hospital, Seoul National University Hospital, Yeungnam University Medical Center, Hanyang University Seoul Hospital, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, Chungnam National University, Kyungpook National University Hospital, Daegu Catholic University Medical Center, Wonju Severance Christian Hospital, Chungnam National University Hospital, National Health Insurance Service Ilsan Hospital, Gachon University Gil Medical Center, Gachon University Medical Center, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Chung-Ang University Hospital, Seoul National University, Seoul National University Bundang Hospital, Samsung Medical Center, Sungkyunkwan University, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Ulsan University Hospital, Sejong General Hospital, The Catholic University of Korea Daejeon St. Mary's Hospital, The Catholic University of Korea St. Vincent's Hospital, Inje University Busan Paik Hospital, Keimyung University Dongsan Hospital, Keimyung University, Soonchunhyang University, Soonchunhyang University Hospital Cheonan

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

OpenAlex ID: W7161541053