Key result
CTO PCI reduces ischaemic burden, shrinking large baseline defects by ~4 segments.
Why the study?
The relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion PCI were not fully established.
Does successful CTO PCI improve absolute myocardial perfusion and reduce ischaemic burden across different baseline defect sizes in patients with chronic total occlusion?
Cohort (n=193)
No
Does successful CTO PCI improve absolute myocardial perfusion and reduce ischaemic burden across different baseline defect sizes in patients with chronic total occlusion?
Effect estimate: median reduction of 1, 2, and 4 segments for limited, moderate, and large defects
p-value: p=<0.01
Successful CTO PCI significantly reduces ischemic burden and improves myocardial blood flow and coronary flow reserve at 3 months, with the greatest reduction in defect size seen in patients with the largest baseline defects.
May support CTO PCI for ischaemic reduction across defect sizes; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: The aim of this study was to explore the relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS AND RESULTS: A total of 193 consecutive patients underwent [15O]H2O positron emission tomography prior to and three months after successful CTO PCI. Change in perfusion defect size, quantitative hyperaemic myocardial blood flow (MBF) and coronary flow reserve (CFR) within the CTO area were compared among patients with limited (0-1 segment, N=15), moderate (2-3 segments, N=61) and large (≥4 segments, N=117) perfusion defects. Median reductions in defect size were 1 [0-1], 2 [1-3], and 4 [2-5] segments in patients with a limited, moderate and large defect (all comparisons p<0.01). Hyperaemic MBF and CFR improved significantly regardless of baseline defect size (overall between groups p=0.45 and p=0.55). After stratification of patients to a low, intermediate or high tertile according to baseline hyperaemic MBF or CFR levels, changes in hyperaemic MBF and CFR after CTO PCI were comparable between tertiles (overall p=0.75 and p=0.79). CONCLUSIONS: Major reductions in ischaemic burden can be achieved following CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperaemic MBF and CFR improve significantly irrespective of their baseline values or perfusion defect size.
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Schumacher et al. (2020) conducted a cohort in Chronic coronary total occlusion (n=193). Percutaneous coronary intervention (PCI) vs. Baseline (pre-PCI) was evaluated on Change in perfusion defect size (median reduction of 1, 2, and 4 segments for limited, moderate, and large defects, p=<0.01). Percutaneous coronary intervention for chronic total occlusion significantly reduced ischaemic burden, yielding median defect size reductions of 1, 2, and 4 segments in patients with limited, moderate, and large baseline defects.
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