@article{484d7a29-0a4a-40c4-88d7-0434bb9db238,
  abstract     = {{<p>Background: The prognostic benefit of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in stable coronary artery disease (CAD) remains uncertain. Objectives: To evaluate long-term survival following CTO PCI compared with medical therapy (MT) using target trial emulation and a nationwide real-world registry. Methods: We included 7813 patients with stable CAD and a documented CTO from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) between 2015 and 2024. CTO PCI was modeled as a time-dependent exposure. The primary outcome was all-cause mortality. We used inverse probability of treatment weighting (IPTW), time-dependent Cox regression, and instrumental variable (IV) analysis to adjust for confounding. Results: Over a median follow-up of 5.08 years, 1253 deaths occurred. While unadjusted survival favored CTO PCI (HR 0.74; 95% CI, 0.64–0.86; p &lt; 0.001), IPTW and IV adjustment showed no significant reduction in mortality compared with MT (IPTW HR 0.94; 95% CI, 0.80–1.10; p = 0.41; IV HR 1.00; 95% CI, 0.71–1.40; p = 0.999). Successful CTO PCI was associated with improved survival (HR 0.74; 95% CI, 0.62–0.87), whereas unsuccessful procedures were not (HR 1.08; 95% CI, 0.79–1.47). Subgroup analyses showed no consistent benefit, although a modest survival advantage was observed in non-diabetic patients. Conclusions: In this large nationwide study using target trial emulation, CTO PCI was not associated with improved overall survival compared with MT. Only successful procedures conferred a benefit, highlighting the importance of procedural success and patient selection in CTO revascularization strategies.</p>}},
  author       = {{Sundström, Joakim and Louca, Antros and Petursson, Petur and Mohammed, Mohammed and Angerås, Oskar and Myredal, Anna and Völz, Sebastian and Dworeck, Christian and Odenstedt, Jacob and Olivecrona, Göran and Jensen, Ulf and Mohammad, Moman A. and Pagonis, Christos and Erlinge, David and Rawshani, Araz and Ioanes, Dan and Råmunddal, Truls}},
  issn         = {{1861-0684}},
  keywords     = {{Chronic total occlusion; Coronary artery disease; Percutaneous coronary intervention}},
  language     = {{eng}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Clinical Research in Cardiology}},
  title        = {{CTO PCI vs. medical therapy in stable CAD : real-world outcomes from a target trial emulation of SCAAR registry data}},
  url          = {{http://dx.doi.org/10.1007/s00392-025-02839-6}},
  doi          = {{10.1007/s00392-025-02839-6}},
  year         = {{2026}},
}