Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction

Chung, Chang-Min; Nakamura, Shigeru; Tanaka, Kõji; Tanigawa, Jun; Kitano, Katsuya; Akiyama, Tatsurou; Matoba, Yoshiki; Katoh, Osamu

doi:10.1002/ccd.10641

Cited by 122 publications

(57 citation statements)

References 99 publications

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“…Thus, we assumed that patients without previous MI with reduced LVEF may be associated with myocardial viability. Moreover, revascularization of CTO lesion could lead to a beneficial effect of recovering LV function in patients with good collateral circulation as our study results 15, 24…”

Section: Discussionsupporting

confidence: 54%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

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BackgroundThe impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well‐developed collaterals is not clear.Methods and ResultsA total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03–0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11–0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58–9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85–9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13–7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15–5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087–0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI.ConclusionsIn our study, successful revascularization by PCI for chronic total occlusion lesions with well‐developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

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Section: Discussionsupporting

confidence: 54%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

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“…Other observational studies have suggested additional benefits, including improvements in survival [1][2][3][4][5] and left ventricular ejection fraction [16][17][18]. In the absence of definitive randomized clinical trial data, further studies are warranted to delineate any potential survival advantage associated with CTO PCI.…”

Section: Discussionmentioning

confidence: 93%

Changes in myocardial ischemic burden following percutaneous coronary intervention of chronic total occlusions

Safley

Koshy

Grantham

et al. 2011

Cathet Cardio Intervent

104

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“…[25][26][27] Successful revascularization of coronary CTO is associated with the improvement of left ventricular function in patients with angina pectoris or old myocardial infarction. [28][29][30] Recently, George and colleagues reported that successful CTO intervention was associated with a decrease in mortality as compared to unsuccessful CTO intervention using large registry data (n = 13,443). 31) Furthermore, Jang and colleagues reported the long-term survival benefit of CTO revascularization as compared to medical therapy using a propensity score-matched population.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

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SummaryRevascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG. (Int Heart J 2016; 57: 565-572) Key words: Percutaneous coronary intervention, Coronary artery bypass grafting, Chronic total occlusion H eart failure is a common disease with a prevalence of 1-2% in the adult population, 1) and still has high mortality in developed countries. One-year mortality rates in population-based studies have been reported to be 25% to 45%.2-5) The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.6) The most common cause of HFrEF is coronary artery disease, which accounts for approximately two-thirds of HFrEF. 7)Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered in heart failure with coronary artery disease, and sometimes improves clinical outcomes including left ventricular function. [8][9][10][11][12] However, revascularization therapy is not always effective in heart failure with coronary artery disease.13) It is unknown which types of patients receive the benefits such as improvement o...

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Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction

Cited by 122 publications

References 99 publications

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Changes in myocardial ischemic burden following percutaneous coronary intervention of chronic total occlusions

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

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