Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

Background The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on left ventricular ejection fraction (LVEF) remains controversial. Methods We included patients who underwent CTO PCI (2018-2022) with reported baseline and follow-up LVEF (window 1-18 months). Stratified analyses according to procedural success, baseline LVEF, and target vessel were performed. Logistic regression analysis was performed to assess predictors of LVEF improvement. Results We included 142 patients with available LVEF data, of whom 121 had successful CTO PCI (85.2%). Overall, mean age was 65.4 ± 10.3 years, 76.1% were men, and 81.0% were White. The attempted CTO vessel was left anterior descending in 31.7%, left circumflex in 17.6%, and right coronary artery in 50.0% of patients. The median time from PCI to follow-up echocardiogram was 8.4 months (IQR, 4.4-12.4). After successful CTO PCI, mean LVEF increased from a baseline of 48.2% ± 15.4% to 51.8% ± 14.2% (ΔLVEF 3.6%; P < .001). Among patients with depressed baseline LVEF <50%, there was greater improvement in LVEF from 32.6% ± 9.7% to 40.0% ± 12.9% (ΔLVEF 7.6%; P < .001), including 48.0% with ≥10% improvement. There was no change in LVEF after unsuccessful CTO PCI (54.6% ± 10.6% vs 55.2% ± 8.6%; P = .746). The ΔLVEF after successful CTO PCI to the left anterior descending, left circumflex, and right coronary artery was 2.6%, 4.0%, and 4.4%, respectively, overall, and 9.4%, 6.3%, 7.3% in patients with depressed baseline LVEF. Reduced baseline LVEF <50% was a strong independent predictor of LVEF improvement after successful CTO PCI (adjusted odds ratio, 5.60; 95% CI, 2.27-13.84; P < .001). Conclusions Successful CTO PCI seems to be associated with modest LVEF improvement, which is more pronounced in patients with reduced baseline LVEF.