Long‐term clinical effects of recanalization of chronic coronary total occlusions in patients with left ventricular systolic dysfunction

Abstract

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 longterm 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.

Long-Term Outcomes of Successful Recanalization Compared With Optimal Medical Therapy for Coronary Chronic Total Occlusions in Patients With and Without Left Ventricular Systolic Dysfunction

“…The rate of TVR observed in our study was consistent with previously reported data, and TVR was the predominant determinant of MACE (19,40,41). In a recent study, Pinto et al reported that, in patients with LV systolic dysfunction, the TVR rate was 29.8% in revascularized CTO group and 15.5% in not revascularized CTO group (31). In addition, Galassi et al also reported, in CTO patients with low LVEF, the rate of TVR was 6.1% in successful CTO PCI group but 0% in failed CTO PCI group (32), which was consistent with our study.…”

“…Clinical outcomes between successful CTO PCI and MT (CTO-PCI not attempted) groups were investigated to better reflect the overall risk of patients with coronary CTO. Our study differs from previous studies (19,31) and is more reflective of the "real world" of clinical practice. To the best of our knowledge, this is the first large cohort study reporting on the long-term outcomes of successful recanalization compared to MT in unselected CTO patients with and without LV dysfunction.…”

Procedural Results and Long-Term Outcomes of Percutaneous Coronary Intervention for in-Stent Restenosis Chronic Total Occlusion Compared with de novo Chronic Total Occlusion

“…The existing literature has suggested an association between recanalization of chronic total occlusion (CTO) by percutaneous intervention and its beneficial effects on clinical outcomes. [1][2][3][4][5] Meanwhile, CTO percutaneous coronary intervention (PCI) has undergone a remarkable improvement in procedural success during the past two decades. 6 CTO secondary to in-stent restenosis (ISR) is not rare, and it is considered as a consequence of late thrombotic stenosis, in-stent atherosclerosis, or endothelium hyperproliferation.…”

Myocardial revascularization by percutaneous coronary intervention in senile patients with chronic total occlusion: a modern view of the problem

“…Пациенты с успешной реканализацией целевой ХОКА были отнесены к группе ХОКА-р, а пациенты с неудачной реканализацией или без неев группу ХОКА-н. При долгосрочном наблюдении пациенты группы ХОКА-н имели значительно более высокий уровень общей и сердечной смертности по сравнению с пациентами, с успешной ЧКВ, а сократительная функция миокарда увеличивалась в среднем на 11-17% [37]. По оценке итальянских коллег, ЧКВ при ХОКА было связано с явной клинической пользой и являлось прогностически благоприятным для пациентов старческого возраста.…”