Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) represents a greater challenge for the interventionist, due to lower procedural success rates, relatively higher incidence of procedural complications, and the increased rate of restenosis. But in recent years, the development of new techniques and equipment increased the success rates. The aims of this study were to determine the contemporary prevalence and the comorbidities of CTO, and the success rate of CTO interventions with minimal budget and equipment in Lombok, Indonesia.

This retrospective cohort study involves patients who underwent coronary angiography from January 2017 to December 2020 in West Nusa Tenggara General Hospital, Lombok, Indonesia. CTO was defined as total coronary artery occlusion of > 3 months.

The prevalence of CTO was 27% (338 patients) among 1,636 patients who underwent angiography during the study period, it was higher than more recent registries which showed a prevalence between 16 and 20%. In baseline characteristics in CTO patients, we found male 85,2%.  The most common age group was 56-65 years (44.9%). Hypertension was a risk factor that was often found 45.1%, followed by diabetes mellitus 20.4%, smoking 18%, and dyslipidemia 16%. The CTO of coronary arteries were located in left anterior descending artery (LAD) (36.1%) followed by right coronary artery (RCA) 27%, both LAD and RCA 12%, left circumflex (LCx) 11%, both LAD and LCx 6%, both LCx and RCA 5%, and triple CTO 3%. Patients with 1 CTO lesion were 73.9%, followed by >1 CTO lesions (26.1%). In this study, patients with CTO were found in triple-vessel disease 47.1%, double-vessel disease 34%, and single-vessel disease 18.9%. The CTO attempt rate reported 61.8%, higher than studies in Canada, only 9-10% of patients underwent PCI, while 57 to 64% of them remained in clinical treatment, and 26 to 34% were referred for coronary artery bypass graft (CABG). Overall procedural success was achieved in 116 lesions (55.8%). Our study has limitation, the J-CTO Score was not reported. CABG procedure has not been available yet in Lombok, Indonesia. Most patients preferred to perform PCI than CABG. 

The prevalence of CTO was 27% in Lombok, Indonesia. Hypertension was the most common cardiovascular risk factor in this study. The most CTO of coronary artery was LAD. The percentage of patients with CTO submitted to PCI was 61.8%.    CTO intervention in rural area could achieve more than 50% success rate. Limited budget and equipment should not be an excuse to attempt CTO lesion.