Hosseini K, Dastjerdi P, Sahzabi RY
… +9 more, Alipoor A, Masanabadi M, Rezvanian P, Daryabari Y, Mehdizadeh M, Soleimani S, Modin D, Skaarup KG, Biering-Sørensen T
Am J Cardiol
· 2026 Jun · PMID 41951138
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Influenza infection increases cardiovascular risk in patients with ischemic heart disease (IHD) or heart failure (HF). This updated meta-analysis evaluated the cardiovascular benefits of influenza vaccination in these po...Influenza infection increases cardiovascular risk in patients with ischemic heart disease (IHD) or heart failure (HF). This updated meta-analysis evaluated the cardiovascular benefits of influenza vaccination in these populations. Two complementary approaches were used: an individual patient data (IPD) meta-analysis for the primary outcome (reconstructed from published Kaplan-Meier curves) and conventional study-level random-effects meta-analyses for all outcomes. Cox models were used to estimate pooled hazard ratios (HRs). Heterogeneity was explored using subgroup, sensitivity, and meta-regression analyses, and study quality was assessed with RoB 2 and ROBINS-I. Twenty-three studies (7 RCTs, 16 observational; n = 1,137,377) met inclusion criteria. Influenza vaccination significantly reduced all-cause mortality (HR = 0.72; 95% CI: 0.63 to 0.82) and cardiovascular mortality (HR = 0.77; 95% CI: 0.67 to 0.89). Vaccinated patients also had a lower risk of MI (HR = 0.81; 95% CI: 0.78 to 0.83), whereas effects on stroke (HR = 0.88; 95% CI: 0.68 to 1.14) and MACE (HR = 0.81; 95% CI: 0.57 to 1.15) were not significant. Reconstructed individual data (n = 22,443) demonstrated a 38% mortality reduction (HR = 0.62; 95% CI: 0.57 to 0.67), with the greatest benefit in the first four months postvaccination. Effects were consistent across age, disease type, study design, and follow-up duration. In conclusion, Influenza vaccination markedly lowers mortality and provides cardiovascular protection in patients with IHD or HF, supporting annual vaccination as an effective secondary prevention strategy.
Hill-Mak J, Wimbish W, Brown E
… +2 more, Wilson P, Kale P
Am J Cardiol
· 2026 Jun · PMID 41951137
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Advanced heart failure (HF) is characterized by high morbidity and mortality, yet palliative care is frequently delayed or underutilized. While prior studies support earlier use of palliative services, outpatient models...Advanced heart failure (HF) is characterized by high morbidity and mortality, yet palliative care is frequently delayed or underutilized. While prior studies support earlier use of palliative services, outpatient models incorporating structured goals-of-care discussions within advanced HF and transplant evaluation remain limited. We describe a clinician-led, embedded approach within a multidisciplinary HF clinic at a tertiary care center, in which HF providers trained in serious illness communication conduct advance care planning as part of routine evaluation for transplant and left ventricular assist device (LVAD) candidacy. Since implementation in January 2023, three HF clinicians have completed formal communication training, and approximately 324 patients have been evaluated using this model. Documentation of serious illness discussions and advance care planning occurred in all eligible patients, with medical decision-making preferences addressed at each visit and caregiver involvement encouraged when appropriate. By integrating these discussions into existing clinical workflows, this model supports timely, continuous, and disease-specific communication without reliance on external referral. In conclusion, embedding palliative care within advanced HF teams is a practical and scalable strategy that may improve alignment of care with patient goals during complex treatment decision-making.
Kong D, Su X, Chen Y
… +6 more, Wei H, Ma Y, Maimaitiaili X, Li Z, Guan L, Mu Y
Am J Cardiol
· 2026 Jun · PMID 41951136
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Chronic heart failure (CHF) patients often present with heterogeneous patterns of cardiac dyssynchrony. Although QRS prolongation (>150 ms) and left bundle branch block (LBBB) are classical markers of electrical dyssynch...Chronic heart failure (CHF) patients often present with heterogeneous patterns of cardiac dyssynchrony. Although QRS prolongation (>150 ms) and left bundle branch block (LBBB) are classical markers of electrical dyssynchrony, their direct association with mechanical dyssynchrony remains controversial. This study aimed to identify key determinants of left ventricular (LV) synchrony using machine learning and explainable artificial intelligence techniques. A cohort of 412 CHF patients was stratified using integrated echocardiographic and electrocardiographic criteria: synchronous group (SG, n = 239) with standard deviation of time to peak longitudinal strain in 18 LV segments (SD18STE) ≤ 33 ms, QRS duration ≤ 120 ms, and left ventricular end-diastolic volume (LVEDV) ≤ 150 mL; asynchronous group (AG, n = 173) with SD18STE > 33 gt; 33 ms typically accompanied by QRS duration > 120 gt; 120 ms and/or LVEDV > 150 gt; 150 mL. All patients underwent speckle tracking echocardiography (STE) to assess LV and left atrial function, along with electrocardiographic evaluation of QRS duration. Key parameters included electrical dyssynchrony markers (QRS duration, LBBB status) and mechanical dyssynchrony markers (LV ejection fraction [EF], end-diastolic volume [EDV], end-systolic volume [ESV], and segmental strain timing). A random forest model was used to identify predictors of mechanical dyssynchrony, and SHapley Additive exPlanations (SHAP) analysis was employed to quantify feature contributions. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1-score. Compared with the SG group, AG patients had significantly higher QRS duration (132 vs. 116 ms, p < 0.001), B-type natriuretic peptide (BNP) levels (2,520 vs. 1,820 pg/mL, p = 0.034), EDV (211 vs. 142 mL, p < 0.001), and ESV (171 vs. 97 mL, p < 0.001), as well as lower EF (21% vs. 34%, p < 0.001). Machine learning identified EF, ESV, and posterior wall segments as the primary predictors of dyssynchrony. SHAP analysis revealed that EF < 40% and ESV > 100 gt; 100 mL increased the probability of dyssynchrony. Posterior wall delays were strongly associated with dyssynchrony. LBBB presence increased the likelihood of dyssynchrony 3-fold. The model demonstrated excellent performance (AUC = 0.925, accuracy = 85.5%, F1-score = 0.878), outperforming traditional dyssynchrony indices. Mechanical dyssynchrony indicators such as EF, ESV, and EDV are superior to electrical markers in predicting LV synchrony. Dysfunction in posterior wall segments significantly contributes to mechanical asynchrony. These findings provide new insights into CHF pathophysiology and support the use of personalized criteria for cardiac resynchronization therapy candidate selection.
Liu M, Yang Y, Zhao Z
… +8 more, Luo Y, Zhu Z, Li J, Syed S, Yang W, Shan Q, Zhou X, Jiang Z
Am J Cardiol
· 2026 Jun · PMID 41942043
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Left bundle branch area pacing (LBBAP) is a physiological pacing modality that preserves ventricular synchrony. In patients with sinus node dysfunction, who frequently exhibit delayed intrinsic atrioventricular conductio...Left bundle branch area pacing (LBBAP) is a physiological pacing modality that preserves ventricular synchrony. In patients with sinus node dysfunction, who frequently exhibit delayed intrinsic atrioventricular conduction, the optimal postimplant programming strategy remains uncertain. Minimal ventricular pacing algorithms prioritize intrinsic conduction but may permit nonphysiological atrioventricular (AV) prolongation, potentially contributing to left atrial remodeling and atrial tachyarrhythmias. This is a prospective, single-center, randomized, open-label trial with blinded endpoint assessment (PROBE design). A total of 216 patients with sinus node dysfunction and successful LBBAP implantation will be randomized 1:1 to either a fixed optimized AV delay strategy (paced AV 150 ms; sensed AV 120 ms; minimal ventricular pacing algorithms disabled) or a minimal ventricular pacing strategy using device-specific algorithms (paced AV 200 ms; sensed AV 150 ms). The primary endpoint is the change in left atrial volume from baseline to 12 months, evaluated in a noninferiority comparison. Secondary endpoints include device-detected atrial high-rate episodes and atrial fibrillation burden (AF burden). In conclusion, this trial is designed to determine whether active optimization of AV synchrony after LBBAP implantation is noninferior to a conventional minimal ventricular pacing strategy in preventing left atrial remodeling and whether it may reduce atrial arrhythmia burden.
Cole A, Ibrahim R, Weight N
… +3 more, Al-Jarshawi M, Costa F, Mamas MA
Am J Cardiol
· 2026 Jun · PMID 41936851
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Individuals with cancer have an elevated risk of mortality following acute myocardial infarction (AMI), yet selecting optimal dual antiplatelet therapy (DAPT) is challenging due to competing risks of thrombosis and bleed...Individuals with cancer have an elevated risk of mortality following acute myocardial infarction (AMI), yet selecting optimal dual antiplatelet therapy (DAPT) is challenging due to competing risks of thrombosis and bleeding. We evaluated patterns of DAPT use and associated outcomes in this population. Using the TriNetX global registry, we identified adults hospitalized with AMI and active cancer who were prescribed DAPT between January 2015 and January 2020. The primary outcome was all-cause mortality at 1 and 5 years. Secondary outcomes were major bleeding events and AMI readmission up to 5 years. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models. Clopidogrel was the most frequently prescribed P2Y12 inhibitor (79%), followed by ticagrelor (16%) and prasugrel (4%). Patients prescribed clopidogrel were older and had greater cardiovascular comorbidity. In a propensity-matched cohort of 8,000 patients, 5-year mortality was 28% with clopidogrel versus 27% with ticagrelor (aHR 1.11, 95% CI 1.01 to 1.23; p = 0.04) and 20% with prasugrel (aHR 1.42, 95% CI 1.12 to 1.81; p = 0.004). Ticagrelor was associated with higher 5-year mortality compared to prasugrel (26% vs 20%; aHR 1.49, 95% CI 1.14 to 1.85; p = 0.003). Major bleeding rates did not differ significantly between treatment groups. The risk of readmission with AMI was lower in the clopidogrel group compared to ticagrelor, aHR 0.91 (0.84, 0.99), p = 0.03. In conclusion, clopidogrel remains the predominant P2Y12 inhibitor used in patients with active cancer presenting with AMI. However, ticagrelor and prasugrel were associated with better long-term survival without increased major bleeding. These findings support further evaluation of potent P2Y12 inhibitors in this high-risk population.
Panoulas V, Schreiber T, Tsintzos SI
… +4 more, Holy CE, Almedhychy A, Moses JW, O'Neill WW
Am J Cardiol
· 2026 Jun · PMID 41935767
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Traditional cardiovascular trials combine adverse events into composites, ignoring the clinical importance and weight of endpoints. The Win Ratio (WR) is a contemporary statistical technique overcoming these limitations....Traditional cardiovascular trials combine adverse events into composites, ignoring the clinical importance and weight of endpoints. The Win Ratio (WR) is a contemporary statistical technique overcoming these limitations. We aimed to evaluate outcomes of high-risk percutaneous coronary intervention supported with Impella versus intra-aortic balloon pump, by pooling data from the PROTECT-II and PROTECT-III studies, using the WR. All patients from PROTECT-II RCT (P-II) and patients from PROTECT-III (P-III) who met P-II inclusion/exclusion criteria were pooled. The WR was based on independently adjudicated major adverse cardiac and cerebrovascular events at 90 days with following hierarchy: (1) mortality; (2) stroke; (3) spontaneous myocardial infarction; (4) rehospitalization; and (5) peri-procedural myocardial infarction. All major adverse cardiac and cerebrovascular events were analyzed as time-to-event outcomes, except peri-procedural myocardial infarction (binary endpoint). Sub-analyzes included: (1) complex cases: patients with atherectomy or unprotected left main or chronic total occlusion, (2) all patients excluding firsts from P-II (learning cases); and (3) Impella P-II and P-III cohorts separately. Win statistics (WR, net benefit, and win odds) were calculated. The primary analysis (719 Impella and 211 intra-aortic balloon pump-supported PCI) yielded a WR of 1.691 in favor of Impella (1.314 to 2.176, p < 0.001), with net benefit of 0.166 (0.084 to 0.247, p < 0.001) and win odds of 1.398 (1.187 to 1.645, p < 0.001). The WR, net benefit and win odds for complex cases remained statistically significant in favor of Impella. Excluding first patients resulted in increased win statistics compared to primary analysis. In conclusion, pooled WR analyzes from P-II and P-III studies demonstrated improved high risk PCI outcomes up to 90 days with Impella compared to intra-aortic balloon pump.
Am J Cardiol
· 2026 Jun · PMID 41935766
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Electrocardiographic (ECG) findings are commonly used to evaluate myocardial infarction (MI), yet their ability to distinguish Type 1 from Type 2 MI in critically ill patients remains uncertain. We conducted a retrospect...Electrocardiographic (ECG) findings are commonly used to evaluate myocardial infarction (MI), yet their ability to distinguish Type 1 from Type 2 MI in critically ill patients remains uncertain. We conducted a retrospective observational study using the MIMIC-IV database to examine associations between ECG features and MI subtype among adult intensive care unit patients with elevated troponin and ICD-10-defined Type 1 or Type 2 MI. Structured ECG interpretation features, including ST segment changes, T-wave abnormalities, QTc prolongation, and arrhythmia were analyzed using multivariable logistic regression. Among 2,159 patients, ST segment elevation was uncommon but significantly associated with Type 1 MI (9.4% vs 3.1%; adjusted odds ratios 2.48, 95% CI 1.31 to 5.15), whereas QTc prolongation was highly prevalent-particularly in Type 2 MI (66.2% vs 52.9%)-and independently associated with lower odds of Type 1 MI (adjusted odd ratios 0.63, 95% CI 0.49 to 0.81). Overall model discrimination was modest (area under the curve 0.73), but diagnostic performance was characterized by near-perfect sensitivity and very low specificity due to substantial class imbalance favoring Type 1 MI. In conclusion, ECG features alone provide limited clinical and mechanistic utility for differentiating Type 1 from Type 2 MI in critically ill patients and should be interpreted within the broader clinical and physiologic context.
Tarantini G, Fabris T, Cecchetto A
… +1 more, Nai Fovino L
Am J Cardiol
· 2026 Jun · PMID 41935764
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Severe raphe calcification in bicuspid aortic valve (BAV) remains a major challenge for transcatheter aortic valve replacement (TAVR), often leading to asymmetric valve expansion, residual gradients, and suboptimal durab...Severe raphe calcification in bicuspid aortic valve (BAV) remains a major challenge for transcatheter aortic valve replacement (TAVR), often leading to asymmetric valve expansion, residual gradients, and suboptimal durability. We report a case of intentional leaflet modification to enable functional "tricuspidalization" of BAV anatomy and facilitate implantation of a larger transcatheter heart valve (THV). In a 76-year-old high-risk patient with severe aortic stenosis and heavily calcified raphe, a modified UNICORN electrosurgical laceration technique was used to split the fused cusps. This approach allowed annular-based sizing and successful implantation of a 23-mm THV, with optimal expansion, no residual gradient, and preserved coronary access. This strategy may improve TAVR outcomes in selected BAV patients. Larger studies are warranted to confirm the safety, reproducibility, and clinical efficacy of this approach.
Huntermann R, Molinari ME, Batista PG
… +7 more, de Oliveira JP, Muniz J, de Lucena LA, Sato MY, Melo ES, Giorgi J, Bacca COF
Am J Cardiol
· 2026 Jun · PMID 41932419
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Chemotherapy-related cardiac dysfunction (CTRCD) is a major limitation of cardiotoxic cancer therapies. Although global longitudinal strain (GLS) allows early detection of myocardial injury, preventive strategies remain...Chemotherapy-related cardiac dysfunction (CTRCD) is a major limitation of cardiotoxic cancer therapies. Although global longitudinal strain (GLS) allows early detection of myocardial injury, preventive strategies remain scarce. Angiotensin receptor-neprilysin inhibitors (ARNIs) may offer cardioprotection, but current evidence is limited. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating Sacubitril/Valsartan versus control in patients undergoing chemotherapy. PubMed, Embase, and Cochrane databases were searched. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed for binary and continuous outcomes. Four randomized controlled trials comprising 412 participants were included; 42.7% received ARNI therapy, with follow-up ranging from 6 to 18 months. Compared with control, ARNI significantly preserved left ventricular systolic function (MD 1.47%, 95% CI 0.59-2.34) and attenuated GLS deterioration (MD -0.93%, 95% CI -1.49 to -0.38). However, ARNI did not significantly reduce the incidence of CTRCD (RR 0.40, 95% CI 0.08-1.97) or all-cause mortality (RR 0.63, 95% CI 0.08-5.01). ARNI increased the risk of hypotension but had no significant effects on NT-proBNP or dyspnea. In conclusion, ARNI therapy improves GLS and left ventricular ejection fraction during chemotherapy but has not yet demonstrated reductions in CTRCD or mortality. Hypotension remains a key safety consideration.
Yoshikawa H, Iwasaki M, Amemiya K
… +2 more, Kujime S, Yoshikawa M
Am J Cardiol
· 2026 Jun · PMID 41932418
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AIMS: The temporal behavior of natriuretic peptides and echocardiographic indices during hemodialysis (HD) remains incompletely characterized. We aimed to delineate their dynamic profiles and rank the timing of changes w...AIMS: The temporal behavior of natriuretic peptides and echocardiographic indices during hemodialysis (HD) remains incompletely characterized. We aimed to delineate their dynamic profiles and rank the timing of changes within a single HD session. METHODS AND RESULTS: In a cohort of 75 HD patients, time points at pre, 1 hour, 2 hours, 3 hours, and post HD were assessed for B-type natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and echocardiographic indices of diastolic function (E/A, E/e'), cardiac structure (left atrial volume index [LAVI], left ventricular mass index), venous load (tricuspid regurgitation pressure gradient [TRPG], inferior vena cava collapsibility index [IVC-CI]), and myocardial deformation (global longitudinal strain [GLS]). Using normalized time (0-1) and linear mixed-effects models, we derived t20, t50, and Lag (t_peak - t20). BNP and hANP declined early. BNP showed the earliest t20, followed by hANP; E/e' and E/A clustered early, LAVI and TRPG mid-session, GLS and LVMI later, and IVC-CI latest. BNP had the longest Lag; hANP, E/e', LAVI, and TRPG formed an intermediate cluster, left ventricular mass index and GLS were slightly shorter, and IVC-CI was the shortest. For t50, the ranking was broadly similar, with BNP reaching 50% of its total change earlier than hANP (p < 0.0001). CONCLUSIONS: A temporal hierarchy emerged-from immediate peptide responses, through chamber and pressure changes, to late structural adaptation-providing a framework to interpret intradialytic cardiac responses and guide volume control in HD. The t50 metric quantifies response speed without requiring an arbitrary absolute cut-off and may inform decongestion strategies beyond HD, including heart failure care.
Leone PP, Gitto M, Regazzoli D
… +11 more, Calamita G, Tartaglia F, Gioia F, Cozzi O, Gasparini G, Stefanini GG, Rossi ML, Mangieri A, Reimers B, Latib A, Colombo A
Am J Cardiol
· 2026 Jun · PMID 41916500
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Sirolimus-coated balloons (SCB) have been recently introduced for percutaneous coronary intervention (PCI). Nonetheless, evidence on the comparison of different SCB is scant. We aim to compare clinical outcomes after per...Sirolimus-coated balloons (SCB) have been recently introduced for percutaneous coronary intervention (PCI). Nonetheless, evidence on the comparison of different SCB is scant. We aim to compare clinical outcomes after percutaneous coronary intervention with 2 different SCB. SIROMILANO is an observational, retrospective, investigator-driven cohort study conducted at 2 Italian centers, and enrolling between May 2021 and December 2023, consecutive all-comer patients treated with biodegradable polymer microsphere SELUTION SLR SCB (SLR SCB [Cordis, Miami, FL]) or phospholipid nanocarrier Magic Touch SCB (MT SCB [Concept Medical, Surat, India]) for de novo lesions or in-stent restenosis. Adjustment via inverse probability of treatment weighting was applied. Primary end point was rate of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization (TLR), at 12-month follow-up. A total of 668 patients (n = 769 lesions) were enrolled, of which 204 patients were treated with SLR (n = 253 lesions, 70% [n = 178] de novo) and 464 patients with MT (n = 516 lesions, 65% [n = 338] de novo). At a median follow-up of 386 [246-606] days, the 12-month rate of TLF was similar with SLR versus MT (7.4% [n = 13] vs 10.5% [n = 35], adjusted hazard ratio [AHR] 0.67, 95% confidence interval [CI] 0.34-1.33). No difference in risk of cardiac death (AHR 1.88, 95% CI 0.36-9.91), target vessel MI (AHR 1.81, 95% CI 0.13-25.3) or TLR (AHR 0.60, 95% CI 0.28-1.29) was present between groups. Among patients treated in vessels ≥3 mm in diameter (512 lesions [66.6%]), the risk of TLF at 12-month follow-up was similar between groups (AHR 0.49, 95% CI 0.23-1.06). In conclusion, SIROMILANO identified no statistically significant differences in clinical outcomes at 12-month follow-up after biodegradable polymer microsphere SLR SCB versus phospholipid nanocarrier MT SCB angioplasty among patients with coronary artery disease.
Hadri SH, Tareen N, Javed H
… +4 more, Hassan A, Naseer M, Ali K, Sajjad A
Am J Cardiol
· 2026 Jun · PMID 41916499
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Heart diseases together with circulatory diseases known as cardiovascular diseases maintain their position as the world's leading cause of mortality because these disorders killed about 33% of people during 2021. Medical...Heart diseases together with circulatory diseases known as cardiovascular diseases maintain their position as the world's leading cause of mortality because these disorders killed about 33% of people during 2021. Medical progress and diagnostic innovation have not addressed the major obstacles within current therapeutic approaches, which involve systemic toxicity together with non-specific drug distribution and invasive medical interventions. The field of nanotechnology delivers beneficial solutions through its capacity to direct medications, along with managing their release mechanisms and improving visualization precision. Therapeutic efficacy gets enhanced with diminished side effects through the application of nanoparticle (NP)-based systems, including polymeric NPs, liposomes, dendrimers, and solid lipid NPs. The field of molecular imaging and regenerative cardiology has experienced advancements through the implementation of novel nanomaterials, including gold NPs, carbon nanotubes, and graphene derivatives. This analysis examines current developments in nanomedicine, which supports cardiovascular disease diagnostics and therapy while demonstrating its ability to revolutionize precise cardiology practices through specific treatments, along with minimally invasive tests and integrated therapeutic systems.
Am J Cardiol
· 2026 Jun · PMID 41912003
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Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has shown a higher procedural risk. The goal of this study was to compare complications and mortality of patients undergoing CTO-PCI with patient...Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has shown a higher procedural risk. The goal of this study was to compare complications and mortality of patients undergoing CTO-PCI with patients without CTO (non-CTO-PCI) by using propensity score matching. The national Inpatient Sample database (NIS), years 2016-2020, was studied using International Classification of Diseases, Tenth Revision Codes. Among 501,680 PCI hospitalizations, 250,840 had CTO-PCI and none-CTO-PCI. After matching, CTO-PCI had higher mortality (3.12% vs 2.62%, OR: 1.20, CI: 1.1 to 1.29, p <0.001) and higher odds of procedure-related myocardial infarction (0.65% vs 0.28%, (OR: 2.39, CI: 1.95-2.92, p <0.001), perforation (0.62% vs 0.19%, OR: 3.33, CI: 2.63 to 4.22, p <0.001), tamponade (0.40% vs 0.18%, OR: 2.18, CI: 1.7 to 2.8, p <0.001), procedural bleeding (1.13% vs 0.63%, OR: 1.8, CI: 1.57 to 2.07, p <0.001), post procedural cerebral infarction (0.03 vs 0.01, OR: 2.43, CI: 0.99 to 5.94, p = 0.05), acute post procedural respiratory failure (0.45% vs. 0.23%, OR: 1.96, CI: 1.56-2.47, p <0.001) and contrast induced nephropathy (0.07% vs 0.04%, OR: 1.95, CI: 1.10 to 3.44, p = 0.02). Overall risk for all complications was more than double (2.56% vs 1.21%, OR: 2.14; 1.93-2.37, p <0.001). When perforation, tamponade, or bleeding occurred, mortality was significantly higher in CTO-PCI compared to non-CTO-PCI (perforations: 2.43% vs. 0.69 %, p <0.001, tamponade: 2.88% vs 1.68%, p = 0.03 and bleeding 2.30% vs 1.14%, p = 0.02). In conclusion, propensity-matched national cohort confirmed that CTO-PCI was associated with higher in-hospital complications and mortality compared to non-CTO-PCI, mostly driven by perforation, bleeding, and tamponade. These findings support the previous report that CTO-PCI is associated with worse in-hospital outcomes.