The Gulf Chronic Total Occlusion Registry: Short- and Long-Term Outcomes Across Management Strategies

Daoulah, A; Kahin, MA; Panduranga, P; Almahmeed, W; Abdulhabeeb, IAM; Alkindi, F; Lotfi, A; Seraj, S; Jamjoom, A; Arafat, AA; Kanbr, O; Hussien, AF; Alamro, B; Anthony, H; AlEidan, IM; Livingston, GS; Almarghany, AA; Aslan, AN; Elamin, SMS; Al Mashari, S; Shantouf, R; Noor, TH; Alryami, A; Alosaimi, H; Khan, MA; Dahdouh, Z; Balghith, M; Yousif, N; Noor, HA; Sadiq, A; Al Ismaili, A; Al Azzoni, A; Tammam, K; Jamal, S; Khan, H; Almubarak, M; Alanati, HS; Elmahrouk, Y; Chachar, TS; Abohasan, A; Jouda, AA; AlGhamdi, A; Al Maashani, S; Ismail, MY; Arabi, A; Alquaid, A; Alshehri, M; Ross, EM; Iqbal, MN; Alsaadi, R; Elmahrouk, A

doi:10.1016/j.jacadv.2026.103015

Coronary disease & ACS

The Gulf Chronic Total Occlusion Registry: Short- and Long-Term Outcomes Across Management Strategies

JACC AdvPublished 6 Aug 2026Registry

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Authors' conclusion

After adjustment, no treatment strategy demonstrated superiority for hard cardiovascular outcomes; revascularization, particularly CABG, was associated with a lower angina burden at follow-up.

Study context

Population: Patients with angiographically confirmed chronic total occlusion (CTO), 2021–2023patients with angiographically confirmed CTO
Participants: 741 patients

Exposure: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) vs medical therapy
Medical therapyn = 151
PCIn = 441
CABGn = 149
Outcome: In-hospital major adverse cardiovascular events
Follow-up: In-hospital

Methodological details7 tertiary centers in 4 Gulf countries

7 tertiary centers in 4 Gulf countries

Main finding

As reported in the abstract

After adjustment, neither PCI nor CABG differed significantly from medical therapy
Adjusted

Observational data: associations, not effects.

Further findings

Canadian Cardiovascular Society class I · last follow-up — CABG vs medical therapy · significant · adjusted

P < 0.001

Medical therapy86.2%

PCI91.7%

CABG98.0%

Outcome	P value
Canadian Cardiovascular Society class I · last follow-upPCI vs medical therapy · not significant · adjusted	P = 0.17

Major adverse cardiac and cerebrovascular events-free survival · median follow-up of 22 months; 36-month restricted mean survival time

No statistically significant difference between PCI, CABG, and medical therapy

Adjusted

Baseline characteristics by treatment

Medically managed patients had worse renal function, more severely reduced left ventricular ejection fraction, and more cardiogenic shock despite simpler CTO anatomy
CABG patients had more extensive multivessel disease, whereas PCI patients had greater CTO lesion complexity

Reference

Authors: Daoulah A, Kahin MA, Panduranga P, Almahmeed W, Abdulhabeeb IAM, Alkindi F, et al.
All 51 authors
Daoulah A, Kahin MA, Panduranga P, Almahmeed W, Abdulhabeeb IAM, Alkindi F, Lotfi A, Seraj S, Jamjoom A, Arafat AA, Kanbr O, Hussien AF, Alamro B, Anthony H, AlEidan IM, Livingston GS, Almarghany AA, Aslan AN, Elamin SMS, Al Mashari S, Shantouf R, Noor TH, Alryami A, Alosaimi H, Khan MA, Dahdouh Z, Balghith M, Yousif N, Noor HA, Sadiq A, Al Ismaili A, Al Azzoni A, Tammam K, Jamal S, Khan H, Almubarak M, Alanati HS, Elmahrouk Y, Chachar TS, Abohasan A, Jouda AA, AlGhamdi A, Al Maashani S, Ismail MY, Arabi A, Alquaid A, Alshehri M, Ross EM, Iqbal MN, Alsaadi R, Elmahrouk A
Journal: JACC: Advances
Published: 6 Aug 2026
DOI: 10.1016/j.jacadv.2026.103015
PubMed: 42561488

Topic: Coronary disease & ACS
Also indexed: Interventional cardiology

Exposure definitions

medical therapy: initial strategy of medical therapy
PCI: initial strategy of PCI
CABG: initial strategy of CABG

Original publication

The Gulf Chronic Total Occlusion Registry: Short- and Long-Term Outcomes Across Management Strategies. JACC Adv. Published 6 August 2026. doi:10.1016/j.jacadv.2026.103015

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