Key result
Successful CTO recanalization is linked to lower overall and cardiac mortality in patients with EF ≤45%.
Why the study?
Patient selection for percutaneous CTO revascularization is not standardized, and outcome data in patients with LV systolic dysfunction undergoing PCI for CTO are scarce.
Does successful percutaneous recanalization of chronic total occlusions reduce mortality and myocardial infarction in patients with left ventricular systolic dysfunction (EF ≤45%)?
Cohort (n=436)
Does successful percutaneous recanalization of chronic total occlusions reduce mortality and myocardial infarction in patients with left ventricular systolic dysfunction (EF ≤45%)?
p-value: p=0.021 for overall mortality
Successful recanalization of chronic total occlusions in patients with LV systolic dysfunction is associated with lower long-term all-cause and cardiac mortality compared to failed or unattempted recanalization.
OBJECTIVES: The aim of the present analysis is to evaluate the clinical impact of chronic total occlusions (CTOs) recanalization in patients with left ventricular (LV) systolic dysfunction. BACKGROUND: According to contemporary knowledge, patient selection for percutaneous CTO revascularization is not yet standardized. In particular, data on outcomes in patients with LV systolic dysfunction undergoing percutaneous coronary intervention (PCI) for CTO are scarce. METHODS: From a total of 2,421 consecutive patients with at least one CTO, 436 patients with ejection fraction (EF) ≤45%, who were referred for coronary angiography between January 1998 and September 2014, were selected. Patients with successful recanalization of the target CTO were assigned to CTO-revascularized group and those with failed or not attempted recanalization to the CTO-not revascularized (CTO-NR) group. Study endpoints were all-cause death, cardiac death, and occurrence of myocardial infarction on follow-up. RESULTS: Out of 436 CTO patients with reduced EF, 228 (52.3%) were successfully recanalized and 208 patients (47.7%) were not, either due to CTO-PCI failure (n = 106, 24.3%) or because CTO-PCI was not attempted (n = 102, 23.4%). At long-term follow-up, CTO-NR patients had significantly higher rate of overall (p = .021) and cardiac mortality (p = .035) compared to those successfully revascularized. CONCLUSION: In patients with systolic LV dysfunction (EF ≤ 45%), CTO revascularization was associated with significant lower rate of total and cardiac mortality compared to those with nonrevascularized CTO.
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Pinto et al. (2020) conducted a cohort in Chronic coronary total occlusions with left ventricular systolic dysfunction (n=436). Successful recanalization of chronic total occlusion vs. Failed or not attempted recanalization was evaluated on All-cause death, cardiac death, and occurrence of myocardial infarction (p=0.021 for overall mortality). Successful recanalization of chronic total occlusions in patients with ejection fraction ≤45% was associated with significantly lower overall (P=0.021) and cardiac mortality (P=0.035).
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