# The Critical Role of Nutritional and Procedural Factors in CTO-PCI Patient Prognosis

## TL;DR

This study shows that both the complexity of a heart procedure and a patient's nutritional health strongly affect outcomes in patients undergoing CTO-PCI.

## Contribution

The study introduces the combined use of procedural complexity scores and nutritional status (PNI) to improve risk prediction in CTO-PCI patients.

## Key findings

- Lower Prognostic Nutritional Index (PNI) and higher lesion complexity scores were linked to worse outcomes in CTO-PCI patients.
- A PNI cut-off of 46 predicted mortality with 70.6% sensitivity and 75.2% specificity.
- LVEF, J-CTO score, and PNI were identified as independent predictors of mortality in multivariable analysis.

## Abstract

(1) Background: Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a complex, high-risk procedure compared to standard percutaneous coronary intervention (PCI). Scoring systems such as the Japanese Chronic Total Occlusion (J-CTO), European Chronic Total Occlusion (EuroCTO), and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) evaluate lesion difficulty and predict outcomes. Nutritional status, measured by the Prognostic Nutritional Index (PNI), may also affect procedural success and long-term survival. The objective of this study was to evaluate the combined impact of procedural complexity and nutritional status on the clinical outcomes of patients undergoing CTO-PCI. (2) Methods: We analyzed 118 patients undergoing CTO-PCI between May 2021 and March 2022. Procedural complexity was assessed using the J-CTO, EuroCTO, and PROGRESS-CTO scores, while nutritional status was evaluated using the PNI. Primary outcomes included all-cause mortality and repeat revascularization, which were analyzed using Cox proportional hazards regression and Kaplan–Meier survival analyses. (3) Results: Adverse outcomes occurred in 25 patients (mortality: 17; revascularization: 8). Patients with adverse outcomes had significantly lower left ventricular ejection fraction (LVEF) (46 ± 13.7% vs. 52.1 ± 10.5%, p < 0.001), lower PNI (p < 0.001), and higher J-CTO, EuroCTO, and PROGRESS-CTO scores (all p < 0.05). A PNI cut-off value of 46 predicted mortality with a sensitivity of 70.6% and specificity of 75.2% (area under the curve [AUC] = 0.739, p = 0.001). Multivariable analysis identified LVEF (hazard ratio [HR] 0.966, p = 0.036), J-CTO score (HR 1.598, p = 0.027), and PNI (HR 0.925, p = 0.022) as independent predictors of mortality. (4) Conclusion: Both procedural complexity and nutritional status significantly influence outcomes following CTO-PCI. Incorporating PNI together with procedural complexity scores into pre-procedural assessments may enhance risk stratification and optimize patient management.