Key result
Optimal CTO-PCI revascularization linked to ~55% lower CV death or TVMI risk vs. procedural failure.
Why the study?
The relationship between optimal revascularization for CTO lesions and long-term clinical outcomes in patients with heart failure with or without type 2 diabetes remained unclear.
Does optimal revascularization during CTO-PCI reduce adverse cardiovascular events in patients with heart failure compared to CTO-PCI failure?
Cohort (n=1,591)
No
Does optimal revascularization during CTO-PCI reduce adverse cardiovascular events in patients with heart failure compared to CTO-PCI failure?
Optimal revascularization of chronic total occlusions in patients with heart failure is associated with improved long-term cardiovascular outcomes, particularly in those with concurrent type 2 diabetes.
Answers are grounded in this paper and cite their sources.
Should not yet change CTO-PCI practice in heart failure; hypothesis-generating for randomized confirmation, especially in type 2 diabetes.
BACKGROUND: The relationship between optimal revascularization for chronic total occlusion (CTO) lesions and long-term clinical outcomes in patients with heart failure with or without type 2 diabetes (T2D) remains unclear. Therefore, this study aimed to investigate the association between optimal or nonoptimal CTO percutaneous coronary intervention (CTO-PCI) and long-term adverse clinical outcomes in patients with heart failure with or without T2D. METHODS: This prospective cohort study included 1591 patients with heart failure who underwent CTO-PCI at Fuwai Hospital between January 2017 and December 2018. Patients were categorized based on CTO-PCI outcomes: failure, suboptimal revascularization, and optimal revascularization. The primary end point was a composite of cardiovascular death and target-vessel myocardial infarction (TVMI), whereas the secondary end point was a composite of all-cause death and myocardial infarction. RESULTS: During a median follow-up of 3.3 years, 89 (5.6%) cases of cardiovascular death/TVMI occurred. Patients who received optimal revascularization had significantly lower risks of both cardiovascular death/TVMI (hazard ratio [HR], 0.45 [95% CI, 0.27-0.76]) and all-cause death/myocardial infarction (HR, 0.53 [95% CI, 0.33-0.86]) compared with those with CTO-PCI failure. Subgroup analysis showed that these associations were significant in patients with T2D (cardiovascular death/TVMI: HR, 0.25 [95% CI, 0.13-0.49]; all-cause death/myocardial infarction: HR, 0.28 [95% CI, 0.15-0.53]), but not in those without T2D (cardiovascular death/TVMI: HR, 0.87 [95% CI, 0.32-2.40]; all-cause death/myocardial infarction: HR, 1.06 [95% CI, 0.40-2.85]). CONCLUSIONS: Our findings suggest that optimal revascularization during CTO-PCI is associated with a lower risk of adverse cardiovascular events in patients with heart failure, particularly in those with T2D.
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Song et al. (2026) conducted a cohort in Heart failure with chronic total occlusion (n=1,591). Optimal revascularization (CTO-PCI) vs. CTO-PCI failure was evaluated on Composite of cardiovascular death and target-vessel myocardial infarction (TVMI) (HR 0.45, 95% CI 0.27-0.76, p=0.003). Optimal revascularization during chronic total occlusion percutaneous coronary intervention was associated with a lower risk of cardiovascular death or target-vessel myocardial infarction compared with procedural failure (HR 0.45, 95% CI 0.27-0.76).
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