Key result
CTO-PCI is linked to ~89% fewer ventricular arrhythmias and reduced mortality vs OMT.
Why the study?
Ventricular arrhythmia risk in patients with chronic total coronary occlusion without advanced LV dysfunction is poorly defined, and whether revascularization reduces arrhythmias compared with optimal medical therapy remains unknown.
Does CTO-PCI reduce ventricular arrhythmias and mortality compared to optimal medical therapy in patients with chronic total coronary occlusion and LVEF > 35%?
Cohort (n=100)
No
Does CTO-PCI reduce ventricular arrhythmias and mortality compared to optimal medical therapy in patients with chronic total coronary occlusion and LVEF > 35%?
Absolute Event Rate: 2.3% vs 21.4%
p-value: p=0.01
In patients with chronic total occlusion and LVEF > 35%, successful CTO-PCI was associated with significantly lower rates of ventricular arrhythmias and all-cause mortality compared to optimal medical therapy.
May support CTO-PCI to lower VA risk in preserved EF; leaves open definitive benefit pending randomized trials.
Background Ventricular arrhythmia (VA) risk in patients with chronic total coronary occlusion (CTO) without advanced left ventricular (LV) dysfunction is poorly defined, and whether revascularization reduces VA compared with optimal medical therapy (OMT) remains unknown.Methods We conducted a single-center retrospective cohort study of 100 patients with angiographically confirmed CTO, LVEF > 35%, and no coronary artery bypass surgery after diagnosis between January 2010 and January 2019. CTO percutaneous coronary intervention (CTO-PCI) was performed in 44 patients, while 56 received OMT. Primary outcomes were VA and all-cause mortality at study end. Secondary cardiovascular outcomes were assessed. Kaplan – Meier methods were used for VA and mortality analyses, performed with STATA 15 and RStudio.Results Mean age was 59.9 ± 13.1 years, BMI was 31.8 ± 7.4 kg/m2, 66% were male, 64% White, and 23% Black. Baseline characteristics, including LVEF, CTO number and location, and use of antiarrhythmics, beta-blockers, and statins, were similar between groups. During 4.1 ± 2.5 years of follow-up, OMT was associated with higher VA (21.4% vs 2.3%, p = 0.01) and mortality (37.5% vs 15.9%, p = 0.03) than successful CTO-PCI.Conclusions Among CTO patients with LVEF > 35%, VA and mortality were frequent, particularly with OMT, supporting prospective studies to confirm benefit and refine patient selection for revascularization strategies.
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Jabri et al. (2026) conducted a cohort in chronic total coronary occlusion (CTO) (n=100). CTO percutaneous coronary intervention (CTO-PCI) vs. optimal medical therapy (OMT) was evaluated on ventricular arrhythmia (VA) (p=0.01). CTO-PCI was associated with significantly lower rates of ventricular arrhythmias (2.3% vs 21.4%, p=0.01) and mortality (15.9% vs 37.5%, p=0.03) compared to optimal medical therapy.
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