1000–31 Late Recanalization of Chronic Total Coronary Occlusion: Maintained Vessel Patency Improves Global and Regional Left Ventricular Function and Avoids Remodeling

Abstract

To determine whether late recanalization of total coronary occlusions improved left ventricular (LV) function, we studied LV ejection fraction (EF) and regional wall motion (Stanford method) on RAO 30° LV angiography in 41 consecutive pts (31 M, 10 F; age: 56 ± 9 yrs) who underwent successful percutaneous recanalization of a chronic ( > 10 days), complete (TIMI grade 0) occlusion of either the left anterior descending (LAD) or right coronary artery (RCA) and who had a complete evaluation before and at 6 months following recanalization. At 6 months, 11 pts had reocclusion (Grl) and 30 pts (Gr2) had maintained patency (TIMI grade 3). Evolution of global LV function: in Gr 1, LVEF increased from 53 ± 13 to 61 ± 19% (p = 0.09), due to an increase in LV enddiastolic volume (EDV) from 85 ± 25 to 112 ± 56 ml (p = 0.09), while LV endsystolic volume (ESV) was unchanged (42 ± 22 to 42 ± 29 ml). In contrast, in Gr 2, increase in LVEF (57 ± 14 to 64 ± 13%, P < 0.005) corresponded to a decrease in LVESV (39 ± 29 to 33 ± 22 ml, p = 0.09) while LVEDV remained unchanged (85 ± 41 to 93 ± 53 ml, p = ns). Regional wall motion was assessed on 8 anterior radii for pts with LAD occlusions, and 8 inferior radii for pts with RCA occlusions. In Gr 1, none of the occluded artery-related radii improved. In Gr 2, a significant increase in fractional shortening was present in 7 of 8 occluded artery-related radii, both for LAD and RCA occlusions. Maintained vessel patency after late recanalization of totally occluded coronary arteries improves global and regional LV function without subsequent increase in LV enddiastolic volume; in contrast, when the artery reoceludes, LVEF tends to improve due to an increase in LV enddiastolic volume, corresponding to a remodeling phenomenon. Late ( > 10 days) recanalization of complete coronary occlusions is beneficial to LV function.