Frailty as a Predictor of In-Hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion

<b>Background/Objectives</b>: Data on the prognostic value of frailty in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is limited. This study aimed to evaluate the association between frailty and in-hospital complications in patients undergoing CTO-PCI. <b>Methods</b>: We conducted a retrospective cohort study using administrative data from the National Inpatient Sample (2016-2019). Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorized into three groups: low risk (<5), intermediate risk (5-15), and high risk (>15). Logistic regression models were applied to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital complications. <b>Results</b>: A total of 46,695 patients undergoing CTO-PCI were included. In the adjusted models, patients at high risk of frailty had higher odds of in-hospital mortality (OR 9.51, 95% CI 3.49-26.00), blood transfusion (OR 4.78, 95% CI 1.72-13.20), pericardial complication (OR 16.0, 95% CI 4.85-52.90), and renal replacement therapy (OR 3.83, 95% CI 1.22-12.00) compared to the low-risk group. Intermediate-risk patients also experienced higher odds of most outcomes. <b>Conclusions</b>: Frailty was a significant predictor of in-hospital complications in patients undergoing PCI for CTO. Incorporating frailty assessment into routine clinical practice could enhance risk stratification and enable tailored care strategies for this high-risk population.