Key result
CTO PCI improves hyperemic myocardial blood flow similarly to non-CTO PCI.
Why the study?
The benefits of CTO PCI were being questioned, prompting assessment of its effects on absolute myocardial perfusion compared with PCI of hemodynamically significant non-CTO lesions.
Does percutaneous coronary intervention of chronic total occlusions improve absolute myocardial perfusion similarly to PCI of hemodynamically significant non-CTO lesions in patients with preserved LVEF?
Observational (n=123)
No
Does percutaneous coronary intervention of chronic total occlusions improve absolute myocardial perfusion similarly to PCI of hemodynamically significant non-CTO lesions in patients with preserved LVEF?
Despite greater initial ischemic burden and anatomic complexity, successful CTO PCI achieves comparable absolute restoration of myocardial perfusion as PCI for hemodynamically significant non-occlusive lesions.
Supports comparable perfusion recovery after CTO PCI in preserved LVEF; leaves open randomized outcome confirmation.
Background The benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non‐CTO lesions. Methods Consecutive patients with a preserved left ventricular ejection fraction (≥50%) and a CTO or non‐CTO lesion, in whom [ 15 O]H 2 O positron emission tomography was performed prior and after successful PCI, were included. Change in quantitative (hyperemic) myocardial blood flow (MBF), coronary flow reserve (CFR) and perfusion defect size (in myocardial segments) were compared between CTOs and non‐CTO lesions. Results In total 92 patients with a CTO and 31 patients with a non‐CTO lesion were included. CTOs induced larger perfusion defect sizes (4.51 ± 1.69 vs. 3.23 ± 2.38 segments, P < 0.01) with lower hyperemic MBF (1.30 ± 0.37 vs. 1.58 ± 0.62 mL·min −1 ·g −1 , P < 0.01) and similarly impaired CFR (1.66 ± 0.75 vs. 1.89 ± 0.77, P = 0.17) compared with non‐CTO lesions. After PCI both hyperemic MBF and CFR increased similarly between groups ( P = 0.57 and 0.35) to normal ranges with higher hyperemic MBF values in non‐CTO compared with CTO (2.89 ± 0.94 vs. 2.48 ± 0.73 mL·min −1 ·g −1 , P = 0.03). Perfusion defect sizes decreased similarly after CTO PCI and non‐CTO PCI ( P = 0.14), leading to small residual defect sizes in both groups (1.15 ± 1.44 vs. 0.61 ± 1.45 segments, P = 0.054). Conclusions Myocardial perfusion findings are slightly more hampered in patients with a CTO before and after PCI. Percutaneous revascularization of CTOs, however, improves absolute myocardial perfusion similarly to PCI of hemodynamically significant non‐CTO lesions, leading to satisfying results.
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Schumacher et al. (2018) conducted an observational in Coronary artery disease (chronic total occlusion or hemodynamically significant non-CTO lesion) (n=123). Percutaneous coronary intervention of chronic total occlusions (CTO) vs. Percutaneous coronary intervention of hemodynamically significant non-CTO lesions was evaluated on Change in hyperemic myocardial blood flow (MBF) (p=0.57). Percutaneous coronary intervention of chronic total occlusions improved absolute hyperemic myocardial blood flow similarly to PCI of hemodynamically significant non-CTO lesions (p=0.57 for difference in change).
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