Search Results for: Approfondimenti sulla terapia domiciliare del COVID‑19

Circulation, Volume 148, Issue Suppl_1, Page A17466-A17466, November 6, 2023. Introduction:Universal cholesterol screening during childhood has been recommended by the American Academy of Pediatrics since 2011, but most children remain unscreened. We hypothesized that the COVID-19 pandemic and subsequent disruptions in routine healthcare impacted pediatric cholesterol screening rates and may have disproportionately affected children based on race, ethnicity, socioeconomic status (SES), or rural/urban status.Hypothesis:The COVID-19 pandemic impacted pediatric lipid screening rates based on race, ethnicity, SES, and rural/urban status.Methods:The provider order placement rate (OPR) for a screening cholesterol panel was calculated for established patients 9-21 years old at a single institution pre-pandemic (3/18/2019-3/17/2020), mid-pandemic (3/18/2020-3/17/2021), late-pandemic (3/18/2021-3/17/2022), and post-pandemic (3/18/2022-12/31/2022). OPR was analyzed, including a chi-squared test, based on race, ethnicity, SES, rural/urban status, and the department of the visit.Results:Overall OPR fell over time and in both pediatric and family medicine specialties. There was a decrease in OPR across all race and ethnicity groups, though most did not reach statistical significance. Urban advantaged, urban, and rural underserved had a disproportionately larger decrease in OPR, though all groups had a lower OPR at the end of the study.Conclusions:The OPR decrease in late- and post-pandemic stages may be due to the pandemic. Though OPR differences existed between some rural/urban statuses and the ordering department pre-pandemic, these factors may have worsened these gaps. Future studies are needed to identify and address barriers to pediatric cholesterol screening.

Circulation, Volume 148, Issue Suppl_1, Page A13997-A13997, November 6, 2023. Introduction:Despite the extensive use of average BP for diagnosis of cardiovascular disease (CVD), research has shown that changes in BP variability can better reflect CV deterioration. As patients with type 2 diabetes present to the clinic with pre-established CVD, there is a pressing need for early identification of aberrant BP fluctuations useful for risk appraisal.Hypothesis:We hypothesized that deep learning models with superior capacity in feature extraction would enable comprehensive characterization of arterial pressure (AP) time-series allowing CV risk stratification in early prediabetes.Methods:We trained a convolutional neural network (CNN, Figure 1A) to classify spectrograms generated using short-term Fourier transforms of beat-to-beat AP signals collected from control vs. prediabetic rats of both sexes fed a high-calorie diet for 12 or 24 weeks, representing young and old rats. Model performance was assessed on different sampling rates for binary and multi-level classifications of sex, age, and diet. Saliency maps were generated by back-propagation of model scores to extract frequency values crucial for classification. Conventional frequency domain analysis was performed on the original AP time-series and the power spectral densities (PSD) were determined for the frequencies identified for each classification task. PSD were compared among sex, age, and diet groups using 3-way ANOVA and principal component analysis.Results:The model successfully classified AP spectrograms according to age, sex, and diet revealing sex- and age-specific CV deteriorative processes in early prediabetes (Figure 1B-E). Saliency maps identified frequencies of 2, 13, 19, and 43 Hz as crucial for DietxAgexSex classification. Comparison of PSDs for these frequencies was not sufficient for CV risk separation (Figure 1F, G).Conclusions:Employing a CNN overcomes the shortcomings associated with CV risk stratification using conventional methods.

Circulation, Volume 148, Issue Suppl_1, Page A12119-A12119, November 6, 2023. Introduction:Burnout amongst cardiologists has nearly doubled since the COVID pandemic, but few data describe burnout or its relationship to work environment factors among cardiology team members.Methods:The National Coping with Covid (CwC) Survey included over 1300 cardiology healthcare workers (HCWs). We determined likelihood of burnout among different roles (physicians, advanced practice providers [APPs], nurses [RNs] and other clinical staff [OCS]). Multilevel logistic regression examined independent work life variables in predicting and mitigating burnout, and relationships of burnout to intent to leave current job.Results:The CwC Survey was completed by 1,396 cardiology HCWs (306 MD/ 173 APP/452 RN/ 105 OCS). RNs were most likely to report burnout (59% RNs, 56% OCS, 46% APPs, 40% physicians, p< 0.0001). Work overload was an independent correlate of burnout in all 4 groups, anxiety/depression due to COVID was meaningful in 3 groups, while childcare stress was not related in any group (adjusted Odds Ratios (aORs) 4-17, p’s < 0.005, Table). Feeling valued (FV) was associated with lower burnout in all groups except OCS. A sense of purpose was not significantly associated with lower burnout in any group, although there was a borderline association in physicians (aOR 0.53, p = 0.07). Intent to leave was common, and associated with burnout in all groups, especially APPs (r=0.66) and OCS (r=0.73, p’s < 0.01).Conclusions:Burnout, common among cardiology HCWs, is highest in nurses. While work life variables related to burnout differ between role types, burnout is consistently associated with intent to leave practice. Leaders should recognize that burnout is prevalent among team members, may have different contributors, and has consequences for retention. To prevent burnout in cardiology, strategies such as workload reduction, mental health services and explicitly and effectively valuing workers should be implemented.

Circulation, Volume 148, Issue Suppl_1, Page A15709-A15709, November 6, 2023. Background:SARS-CoV-2 (COVID-19) transmits a multi-systemic disease that can lead to acute respiratory distress syndrome. Growth hormone-releasing hormone receptor (GHRH-R) and its splice variant are expressed in murine and human lung and heart. GHRH-R antagonist, MIA-602, has been shown to regulate inflammation in animal models and immune cell responses to bleomycin lung injury. Using a BSL2-compatible recombinant VSV-eGFP-SARS-CoV-2-S virus (rVSV-SARS-CoV-2-S) which mimics native SARS-CoV-2 infection in K18 hACE2tg mice, we tested our hypothesis that MIA-602 attenuates COVID-19-induced cardiopulmonary injury by reducing inflammation.Methods:Male and female K18-hACE2tg mice were infected with SARS-CoV-2/USA-WA1/2020, rVSV-SARS-CoV-2-S, or PBS and lung viral load, weight-loss and histopathology were compared (N=8). Mice infected with rVSV-SARS-CoV-2-S were subject to daily subcutaneous injections of 10 μg MIA-602 or vehicle (control) starting at 24h post-infection. Pulmonary function was measured via whole-body plethysmography on day 0, day 3, and day 5 (n=7). Five days after viral infection mice were sacrificed, and blood and tissues collected for histopathological analyses, H&E staining, RNA and protein work. Heart and lung tissues were used for RNASeq (n=3 per group). T-test or One-way ANOVA-test was used for statistical analysis.Results:SARS-CoV-2 and rVSV-SARS-CoV-2-S presented similar pathology for weight loss, infectivity (~60%) and histopathologic changes. Daily treatment with MIA-602 ameliorated weight loss, reduced lung inflammation, pneumonia and pulmonary dysfunction evidenced by rescued respiratory rate, expiratory parameters, and dysregulated airway parameters (p

Circulation, Volume 148, Issue Suppl_1, Page A16265-A16265, November 6, 2023. Background:Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease in the United States which can infrequently present with acute hemodynamic instability. Our study aimed to identify the precipitants of acute cardiovascular decompensation resulting in Cardiac Intensive Care Unit (CICU) admission in patients with HCM.Methods:All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1st, 2010, to Dec 31st, 2021, with a diagnosis of CS and co-existing HCM were identified through electronic medical charts. Only those with previously uncorrected HCM in the form of no prior myectomy/alcohol septal ablation and not on mavacamten were included in our study. Chart review was performed by physician investigators to identify the etiology precipitating hemodynamic instability in these patients.Results:Overall, 2754 patients were admitted to our CICU with CS during the study period, of which 21 patients (1%) had coexisting uncorrected HCM. The median age of patients with HCM admitted to our CICU was 61 years, 52% (n=11) were females, and 86% (n=18) were White Americans. The in-hospital mortality of patients with HCM-CS was around 24% (n=5). Retrospective chart review to identify the precipitating agent revealed atrial fibrillation with rapid ventricular response (Afib-RVR) to be the most common precipitant (33%, n=7), followed by severe MR in the setting of dynamic outflow obstruction (19%, n=4) and non-obstructive heart failure (19%, n=4).Conclusion:Identification of the precipitating mechanisms is critical to manage HCM patients presenting with hemodynamic instability. Rapid atrial fibrillation appears to be the most common precipitant leading to hemodynamic instability in this population.

Circulation, Volume 148, Issue Suppl_1, Page A16276-A16276, November 6, 2023. BackgroundCardiac implantable electronic device (CIED) infections are morbid and costly. Atypical organisms are increasingly recognized as a cause of CIED infections. We present a case of recurrent Corynebacterium striatum bacteremia requiring CIED and left ventricular assist device (LVAD) extraction.Case PresentationA 54-year-old female dialysis patient with diabetes, ischemic cardiomyopathy, primary prevention single chamber transvenous defibrillator (ICD) 8 years prior, and destination LVAD presented with chronic C. striatum driveline site infection and relapsing and remitting bacteremia. Over the prior two years, she suffered from chronic driveline infections requiring wound care, driveline washouts, and antibiotics, although not seen by the electrophysiology (EP) team. After a fourth episode of bacteremia, she underwent ICD extraction and LVAD pump exchange, followed by 6 weeks of vancomycin and 3 months of rifampin. She then remained free of bacteremia for 19 months, though continued to demonstrate evidence of driveline infection despite pump exchange. Ultimately, C. striatum bacteremia recurred. Given unrelenting soft tissue infection and recurrent bacteremia, redo LVAD exchange was deferred and she was treated with lifelong suppressive antibiotics.DiscussionCorynebacterium species have historically been considered skin flora, but more recently have been identified as pathogens, both as a cause of endocarditis, and a common organism in LVAD associated soft tissue infections. There are few reports of CIED infection. Source control is difficult in bacteremia patients with both CIED and LVAD. In this case, recurrent bacteremia could be attributed to recurrent driveline-soft tissue infection. However, the prolonged freedom from bacteremia off antibiotics after CIED extraction, despite ongoing soft tissue and driveline infection, argues that her transvenous ICD may have been seeded. This case highlights the growing spectrum of bacteria implicated in CIED-related infection, that early extraction may be a critical intervention regardless of infectious source, and importance of multidisciplinary discussions including heart failure, surgery, infectious disease, and EP to improve outcomes in this complex population.

Circulation, Volume 148, Issue Suppl_1, Page A16269-A16269, November 6, 2023. Background:Published data indicate that 50% of individuals with heart failure and reduced ejection fraction (HFrEF) suffer sudden cardiac death (SCD), however the burden of SCD in heart failure with preserved ejection fraction (HFpEF) remains inconclusive.Aim: Determine the prevalence of HFpEF in a community-based cohort of SCD.Methods:We prospectively identified cases with out-of-hospital SCD in a large metro area of the US Northwest (Pop. 1 million, 2002-2017) and determined HF status prior to SCD based on review of clinical records. Heart failure was subdivided into HFpEF (EF≥50%), HFmrEF (EF 40%-50%), and HFrEF (EF≤40%). In addition, since HFpEF is often underdiagnosed, we evaluated a modified H2FPEF algorithm for the identification of HFpEF among our SCD cohort with unknown HF subtypes. The score was comprised of clinical variables including age, BMI, atrial fibrillation, hypertension, and myocardial infarction. Score accuracy was assessed using receiver operating characteristic (ROC) analysis comparing known HFpEF from clinical records and echocardiography versus non-HF subjects. Next, the score was used to identify missing HFpEF cases within the HF and SCD population.Results:Among 4,683 total SCD cases, 1,013 (22%) had a clinical history of HF. Prevalence of HF sub-types was 42% for HFpEF, 19% for HFmEF and 39% for HFrEF cases. An algorithm score of 5 or greater differentiated HFpEF subjects from non-HF subjects with an AUC of 0.68 (p < 0.01). The algorithm was then deployed on cases with an unknown heart failure subtype and an additional 117 HFpEF subjects were identified. The adjusted total prevalence of HFpEF was 542 subjects (53%) in the SCD the cohort with HF.Conclusion:At least 40% of the SCD cases with HF carry a diagnosis of HFpEF, and our estimates suggest the prevalence may be as high as 53%. Ultimately, these findings highlight the need to develop effective options for primary prevention of SCD in HFpEF patients.

Circulation, Volume 148, Issue Suppl_1, Page A16438-A16438, November 6, 2023. Introduction:The effects of ERT (enzyme replacement therapy) on cardiac manifestations in patients with Fabry disease (FD) are ambiguous. We aimed to investigate the response to ERT using diastolic stress echocardiography (DSE).Hypothesis:Diastolic function of FD would be improved after ERT.Methods:19 patients with FD who underwent ERT were analyzed. All patients had DSE prior to ERT and post ERT at 1 year follow-up. We measured early diastolic (e’) velocity of the mitral annulus at baseline, 25 Watt (W) and peak exercise. The difference of diastolic reserve (ΔDR) between pre and post ERT was calculated. Diastolic reserve is defined as the change of e’ from baseline to 25W or peak of exercise in DSE.Results:Overall diastolic reserve tends to be improved (ΔDR25W: 0.66±1.36, ΔDRpeak 1.47±2.61) after 1 year of the ERT. However, there was no significant change in left ventricular (LV) wall thickness and LV mass index before and after the ERT. When patients were classified into two groups according to ΔDRpeak (Group 1, n=6, ΔDRpeak ≤0; Group 2, n=13, ΔDRpeak >0), group 2 showed more higher pre-ERT MWE (93.6±3.2 vs 84.8±5.0, p

Circulation, Volume 148, Issue Suppl_1, Page A14303-A14303, November 6, 2023. Background:Sudden Cardiac Death (SCD) is an unexpected death attributed to a cardiac cause that occurs within one hour of symptom onset. Males have a higher likelihood of experiencing sudden cardiac arrest compared to females, as evidenced by previous studies indicating a substantial disparity in mortality rates between the genders. The outbreak of the COVID-19 pandemic has had a profound impact on cardiovascular population health patterns. Therefore, our study aimed to assess the influence of the pandemic on the gender-related variation in SCD rates among males and females.Methods:We used the National Inpatient Sample (NIS) to identify all patients admitted to hospitals in 2019 and 2020 with a primary diagnosis of sudden cardiac arrest. To analyze associations, we employed both logistic and linear regression methods, adjusting for potential confounding variables. We set the threshold for statistical significance at a 2-tailed p-value of 0.05.Results:Between 2019 and 2020, a total of 27,430 individuals were admitted to hospitals with a primary diagnosis of sudden cardiac arrest, with 11,705 (42.7%) of these patients being female. When factors such as age, race, hospital bed size, location and teaching status, insurance, and income level, as well as Elixhauser comorbidities and COVID-19 status were considered through multivariate regression analysis, a distinct trend emerged. In the year 2020, which was marked by the COVID-19 pandemic, there was a significant increase in in-hospital mortality among female patients (adjusted Odds Ratio aOR 1.34, 95% Confidence Interval CI 1.04 – 1.79). This trend was not present in the previous year, 2019, prior to the pandemic (aOR 1.03, 95% CI 0.87 – 1.22).Conclusion:Our study revealed a significant increase in mortality among female patients presenting with sudden cardiac arrest during the Covid-19 pandemic. We attribute this increase to the intricate interplay between Covid-19 and the healthcare system. While a direct association between SCD and Covid-19 is possible, it is crucial to acknowledge the indirect ramifications such as the impact of lockdown measures, alterations in behavior, and challenges faced by the healthcare system, all of which may be contributing factors.

Circulation, Volume 148, Issue Suppl_1, Page A12908-A12908, November 6, 2023. Introduction:The Food and Drug Administration (FDA) provides guidance on the use of endpoints for drug approvals in heart failure (HF).Hypothesis:The aim of this study was to systematically review whether clinical studies in HF report the FDA recommendations for endpoints.Methods:All studies targeting HF available on the clinical trials platform from the National Library of Medicine were analyzed. The FDA recommends a decrease in mortality as the primary efficacy endpoint and an increase in survival as the safety endpoint. Others include single or composite scores of hospitalizations, biomarkers, or symptoms and/or physical function.Results:Trials (n=4,978) were narrowed down to 1,299 (26%) studies with an active, but not recruiting, enrolling by invitations, not yet recruiting, and recruiting statuses. Only 132 (3%) studies using intervention with drugs reported endpoints. Up to 7,200 participants were randomly (n=95, 72%) assigned to parallel designs (n=81, 61%) followed by single group (n=19, 14%) or crossover designs (n=18, 14%) with open label (n=48, 36%) or quadruple masking methods (n=29, 22%). Interventions tested sodium-glucose co-transporter 2 (n=21, 16%) and angiotensin receptor-neprilysin inhibitors (n=13, 10%). Dapagliflozin (n=8, 8%), Sacubitril and Valsartan (n=6, 6%) followed by Levosimendan, Metformin, or Warfarin (n=3, 3%) were compared to placebo (n=51, 53%). Equivalence trials (n=35, 27%) analyzed Sacubitril and Valsartan (n=5, 14%), Dapagliflozin, Beta-hydroxybutyrate Ester, or Sacubitril and Valsartan with Para-aminohippurate, Lohexol, and Aprepitant (n=2, 6%). Most studies (n=55, 42%) assessed endpoints related to symptoms and/or physical function. Other endpoints included cardiac function (n=24, 18%) and biomarkers (n=19, 14%) followed by mortality and survival (n=18, 14%) or hospitalization (n=5, 4%).Conclusions:Most studies assessed symptoms, physical function, cardiac function, or biomarkers for primary endpoints. They have included non-fatal endpoints such as patient-reported outcomes or objective indicators likely due to the increasing number of patients with worsening heart failure in outpatient settings.

Circulation, Volume 148, Issue Suppl_1, Page A14541-A14541, November 6, 2023. Background:Pericardiocentesis in patients with Pulmonary Hypertension (PH) and pericardial effusions has unclear benefits, as it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population is limited.Aims.Describe pericardiocentesis-related patient characteristics and in-hospital outcomes in patients with PH versus without.Methods:The National Inpatient Sample database was used to identify adult patients undergoing pericardiocentesis during hospitalizations between 2016 and 2020. Data were stratified between patients with and without PH. A multivariate regression model was used to estimate the association of PH with pericardiocentesis in-hospital outcomes, adjusting for statistically significant comorbidities.Results:A total of 95,665 hospitalizations with a procedure diagnosis of pericardiocentesis were included, of which 7,770 had PH. Patients with PH tended to be older (67 ± 15.7) and female (56%), had significantly higher rates of hypertension (79% vs 66%, P

Circulation, Volume 148, Issue Suppl_1, Page A14432-A14432, November 6, 2023. Poor glycemic control in type 1 diabetes (T1D) may result in cardiovascular disease. Self-care, or the process of maintaining health through health-promoting behaviors and managing illnesses when changes are detected, may improve glycemic control and outcomes. However, self-care in T1D is ill-defined. We examined how self-care maintenance, monitoring, and management cluster in adults with T1D and identified unique characteristics of individuals within each cluster. Adults (n=200, 27% Black, 61% female) with T1D (median[IQR] age: 35 [22] years, T1D duration: 19 [19] years, insulin pump use: 68%) reported personal, clinical and social determinants of health (SDH; modified PRAPARE tool, scored 0-22; higher is worse) and the Self-Care of Diabetes Inventory (3 self-care scales: maintenance, monitoring, management; 1 confidence scale; scored 0-100; scores ≥ 70 are adequate). Cluster analysis was performed with self-care domains as criteria via Ward’s method. To compare clusters, Kruskal-Wallis and chi-square tests were used for continuous and categorical variables, respectively. Three self-care clusters were found and labeled: Mastery (n= 70, 70% White, insulin pump use: 63%, median [IQR] age: 41 [28] years, T1D: 22 [22] years, Self-Care Maintenance: 85.4 [10.4], Monitoring: 82.4 [8.8], Management: 72.2 [13.9], Confidence: 95.5 [11.4], SDH: 2 [2]); Inconsistent (n= 112, 75% White, Insulin Pump use: 75%, median[IQR] age: 34 [22] years, T1D: 19 [18] years, Self-Care Maintenance: 79.2 [12.5], Monitoring: 67.7 [11.8], Management: 58.3 [13.9], Confidence: 88.6 [15.9], SDH: 3 [2]); and Novice (n= 18, 39% White, Insulin pump use: 44%, median[IQR] age: 25 [9] years, T1D: 14 [10] years, Self-Care Maintenance: 53.1 [9.9], Monitoring: 52.9 [13.2], Management: 44.4 [9.7], Confidence: 64.8 [27.8], SDH: 6 [7]). Significant differences were found for age (p

Circulation, Volume 148, Issue Suppl_1, Page A17708-A17708, November 6, 2023. Case Presentation:A 56yo woman with a 12-year history of idiopathic pHTN and severe RV dysfunction presented with worsening exertional angina (CCS III). Perfusion imaging demonstrated a large apical-septal defect, corresponding to an 80% eccentric stenosis of the LMCA on angiography (Fig 1AB) due to compression on ostium and shaft by a severely dilated pulmonary trunk (Fig 1C). Right heart catheterization revealed pulmonary artery pressures (PAPs) of 90/40/68mmHg. Operative risk for CABG was deemed prohibitive, thus the patient underwent high-risk PCI of the LMCA under IV conscious sedation. Initial angiography confirmed a patent LMCA with minimal longitudinal compression. Opening PAPs (102/37/64mmHg) with supplemental oxygen (FiO2/PaO20.76/168mmHg) were similar to preop findings (Fig 1D). To replicate her symptomatology, supplemental oxygen was discontinued, resulting in rapid worsening of LMCA compression with severe reduction in LMCA cross-sectional area at room air conditions (FiO2/PaO20.21/70mmHg), with corresponding suprasystemic PAP (122/44/73mmHg) (Fig 1E). Under IVUS guidance, a preselected stent was deployed producing complete LMCA patency without evidence of dynamic compression; minimal stent areas were unchanged at supraphysiologic and physiologic conditions: 19 vs 20mm2, FiO20.73 vs 0.21 (Fig 1F).Discussion:LMCA stenosis from extrinsic compression of the vessel by an enlarged pulmonary artery is a rare etiology of acute coronary syndromes. Treatment options include PCI, CABG, reimplantation, or PA reduction plasty. While preop imaging clearly demonstrated LMCA compression by a dilated PA, during PCI true and dynamic severity of LMCA compression was revealed only under “normoxic conditions” (FiO20.21). This paroxysmal “nut-cracker” phenomenon from inadvertent reversal of dynamic LMCA compression highlights the importance of normoxia in making the diagnosis of such anomalies in susceptible individuals with pHTN.

Circulation, Volume 148, Issue Suppl_1, Page A12840-A12840, November 6, 2023. Background:Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the risk stratification for HF in AF patients.Hypothesis:Left atrial diameter (LAD) is a simple prognostic parameter in patients with HF. We hypothesized that LAD is a useful predictor for incident HF in AF patients even without pre-existing HF.Methods:The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction

Circulation, Volume 148, Issue Suppl_1, Page A18273-A18273, November 6, 2023. Background:Mitral annular calcification (MAC) is common in hypertrophic cardiomyopathy (HCM), usually accompanied by mitral leaflet calcification, subvalvular apparatus calcification, and mitral valve dysfunction. However, the impact of MAC on surgical strategy and clinical outcomes in HCM is not fully understood.Methods:This cohort enrolled 1035 consecutively recruited patients diagnosed with HCM between January 2016 and December 2021. All patients received a computed tomographic scan prior to surgery.Results:Of the 1035 patients, 112 (10.8%) had MAC, including 39 patients with moderate or severe MAC (calcification area greater than one-third of the annulus). Patients with MAC were significantly older (59.6±8.2 years vs. 47.5±12.3 years, p

Circulation, Volume 148, Issue Suppl_1, Page A12063-A12063, November 6, 2023. Introduction:Although discouraged, ad hoc chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is occasionally performed.Methods:We examined the clinical, angiographic characteristics and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).Results:Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9 ± 1.2 vs 2.4 ± 1.3, p