Observational studyBMJ open2026
Bleeding complications after percutaneous coronary intervention of CTO lesions versus non-CTO lesions: a prospective observational study from the South-East Netherlands Heart Registration (ZON-HR).
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06512493 (South East), which is not on this map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
South East (Zuid Oost) Netherlands Heart Registry (ZON-HR)
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known for higher adverse event rates compared with non-CTO PCI. Comparative outcomes with respect to bleeding events remain limited.
objectivesTo evaluate bleeding events in patients undergoing CTO PCI compared with non-CTO PCI and to identify patient and procedural characteristics associated with bleeding events. DESIGN AND
settingProspective multicentre study of ongoing collected data registered within the South-East Netherlands Heart Registry (Zuid-Oost Nederland Hart Registratie, ZON-HR).
participantsAll consecutive patients with coronary artery disease undergoing clinically indicated PCI are included in the ZON-HR since November 2020.
resultsAt the time of analyses, the ZON-HR consisted of 8264 included patients with 30-day follow-up between November 2020 and December 2023. A total of 8162 patients were included once in the registry. CTO PCI was performed in 410 (5.0%) patients and non-CTO PCI in 7854 (95.0%) patients. Bleeding events occurred more frequently in patients undergoing CTO PCI compared with non-CTO PCI (9.0% vs 5.4%, p<0.01), driven by a significantly higher rate of access-site bleeding events (7.6% vs 3.2%, p<0.01). After multivariable analysis, CTO was not significantly associated with the occurrence of access-site bleeding events (adjusted HR (aHR) 1.39 (95% CI 0.92 to 2.11)). Access-site bleeding events were associated with female sex (aHR 1.71 (95% CI 1.34 to 2.18)), peripheral artery disease (aHR 1.39 (95% CI 1.02 to 1.89)), oral anticoagulation use (aHR 1.34 (95% CI 1.00 to 1.78)), femoral artery access (aHR 2.90 (95% CI 2.08 to 4.05)) and left main PCI (aHR 1.50 (95% CI 1.04 to 2.14)).
conclusionsThe incidence of bleeding events is higher in patients undergoing CTO PCI and particularly driven by access-site bleeding events. The apparent correlation is attributed to non-modifiable and modifiable patient-related and procedure-related characteristics rather than the CTO PCI itself. TRIAL REGISTRATION NUMBER: NCT06512493.
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