Abstract 4360068: Cardio-Kidney-Metabolic Syndrome in Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Cardio-kidney-metabolic (CKM) syndrome, characterized by coronary artery disease, diabetes mellitus (DM), obesity, and chronic kidney disease (CKD), is linked to poor cardiovascular (CV) outcomes. Its impact on procedural complexity and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains unclear. Methods: Our study included 9,133 CTO PCIs performed at 51 centers worldwide between 2012 and 2024. Procedural and angiographic characteristics were compared between patients with and without CKM syndrome. Multivariable logistic regression was used to evaluate the association of CKM syndrome with technical success and MACE. Results: Patients who udnerwent CTO PCI were stratified into five groups: control (n=2,732), obesity (n=1,990), obesity + DM (n=1,739), obesity + CKD (n=1,200), and obesity + CKD + DM (CKM, n=1,472). Compared with the other groups, CKM patients had more CV risk factors, including prior myocardial infarction (control 40.8%, obesity 39.6%, obesity+DM 41.1%, obesity+CKD 44.6%, CKM 45.6%; p=0.002). Angiographic complexity increased across groups: moderate-to-severe calcification (control 38.4%, obesity 37.1%, obesity+DM 46.4%, obesity+CKD 46.0%, CKM 55.7%; p<0.001), moderate-to-severe proximal tortuosity (24.1%, 24.7%, 26.7%, 26.5%, 33.0%, respectively, p<0.001), and proximal cap ambiguity (32.9%, 35.2%, 34.1%, 37.2%, 37.3%, respectively, p=0.027). Compared with control, obesity, obesity + DM, and obesity + CKD groups, CKM patients required significantly more often retrograde crossing (33.2% vs. 28.1%, 31.3%, 30.0%, and 34.2%, respectively; p<0.001). CKM syndrome was also associated with higher prevalence of balloon-uncrossable lesions (12.1% vs. 7.9%, 7.3%, 10.0%, and 8.3%, respectively; p<0.001) and balloon-undilatable lesions (11.7% vs. 4.3%, 4.8%, 7.8%, and 8.5%, respectively; p<0.001). Procedural duration was significantly longer in CKM patients compared with control, obesity, obesity + DM, and obesity + CKD groups (median procedural time: 122 vs. 103, 110, 112, and 114 minutes, respectively; p<0.001) After adjustment, CKM syndrome was not significantly associated with higher risk of MACE (odds ratio [OR] 0.96, 95% Confidence Interval [CI] 0.50–1.83) or with technical success (OR 0.79, 95% CI 0.59–1.50). Conclusion: CKM syndrome is associated with higher lesion and procedural complexity in CTO PCI but is not independently associated with technical success or MACE.