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February 8, 2026

The impact of left ventricular ejection fraction on 3-year outcomes in patients with coronary chronic total occlusion

YKY H KimKangwon National University AHA Y HerKangwon National University SRS W RhaKorea University Medical Center

Key Points

This research aims to evaluate the impact of left ventricular ejection fraction on 3-year outcomes in patients with coronary chronic total occlusion.
Enrolled 1,672 patients from a cardiovascular center registry between 2004 and 2021.
Categorized patients into three groups based on left ventricular ejection fraction: HFrEF, HFmrEF, HFpEF.
Analyzed outcomes including all-cause mortality and revascularization rates.
HFrEF group showed higher all-cause mortality rates compared to HFmrEF and HFpEF groups.
HFmrEF had significantly higher revascularization rates than HFpEF group.
Identified predictors of mortality included old age, myocardial infarction, and multivessel disease.

Abstract

Abstract Background Since there are very few reported studies on this topic, we aimed to compare the 3-year outcomes among three groups of patients with coronary chronic total occlusion (CTO) based on their left ventricular ejection fraction (LVEF): heart failure (HF) with reduced ejection fraction (HFrEF, ≤40%), HF with mildly reduced ejection fraction (HFmrEF, 41–49%), and HF with preserved ejection fraction (HFpEF, ≥50%) Methods A total of 1,672 patients were enrolled from the CTO registry of a cardiovascular center between January 2004 and January 2021. After applying the exclusion criteria, a total of 1,255 patients were categorized into three groups: HFrEF (n=157), HFmrEF (n=185), and HFpEF (n=913). The primary outcome of this study was the all-cause mortality rate. The secondary outcomes included cardiac death (CD), non-cardiac death (NCD), myocardial infarction (MI), and any revascularization rate, including target lesions (CTO vessel), target vessels (CTO vessel), and non-target vessels (non-CTO vessels). Results After adjustment, HFrEF group exhibited higher rates of all-cause mortality (p=0.004 and p0.001, respectively) and CD (p=0.005 and p0.001, respectively) compared with HFmrEF group and HFpEF group. HFmrEF group had significantly higher rates of any revascularization, TLR (CTO vessel), and TVR (CTO vessel) compared to HFpEF group. Old age (≥65 years), myocardial infarction, non-use of renin-angiotensin system inhibitor, and multivessel disease were significant independent predictors of all-cause mortality. Old age, myocardial infarction, diabetes mellitus, the mean number of CTO lesions, and multivessel disease were significant independent predictors of any revascularization Conclusion In this single-center prospective CTO registry study, all-cause mortality was higher in the HFrEF group than in the HFmrEF and HFpEF groups, while there was no significant difference between the HFmrEF and HFpEF groups. However, the HFmrEF group had a higher rate of any revascularization compared to the HFpEF group.

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