Abstract
Background: The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs. optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function.Methods: A total of 1,895 patients with CTOs were stratified according to LV function. Of these, 1,420 patients (74.9%) with LV ejection fraction (LVEF) >45% and 475 patients (25.1%) with LVEF ≤45% were treated with optimal MT or successful CTO percutaneous coronary intervention (PCI). A 1:1 propensity score matching (PSM) was conducted to reduce the impact of potential confounding on the outcomes. The primary outcome was the frequency of major adverse cardiac events (MACEs).Results: Throughout a 2.6-year follow-up and after adjusting for confounders, among patients with preserved LV function, successful CTO PCI was associated with reduced incidence of MACE (14.2 vs. 23.9%, adjusted HR 0.63, 95% CI 0.48–0.83, p = 0.001) compared to MT. There was no significant difference in MACE occurrence (29.6 vs. 28.9%, adjusted HR 1.05, 95% CI: 0.71–1.56, p = 0.792) between successful recanalization and MT in patients with LV systolic dysfunction. The primary outcome among patients with impaired and preserved LV systolic function after PSM was similar to that from earlier findings before PSM was conducted. A significant interaction between LV function and therapeutic strategy for MACE was observed (interaction p = 0.038).Conclusions: Compared to MT alone for management of patients with CTOs, successful CTO PCI may reduce the risk of MACE in patients with preserved LV systolic function, but not in patients with LV dysfunction.
Highlights
Coronary chronic total occlusions (CTOs) are observed in 10–15% of all patients undergoing coronary angiography and remain one of the most challenging obstacles in coronary intervention [1, 2]
476 patients underwent a failed percutaneous coronary interventions (PCIs) (360 patients were with left ventricular ejection fraction (LVEF) >45% and 116 patients were with left ventricular (LV) systolic dysfunction)
Patients with LV systolic dysfunction tended to be male and smokers and had a higher prevalence of previous myocardial infarction (MI) and chronic kidney disease (CKD) compared to patients with preserved LV systolic function
Summary
Coronary chronic total occlusions (CTOs) are observed in 10–15% of all patients undergoing coronary angiography and remain one of the most challenging obstacles in coronary intervention [1, 2]. The presence of a CTO was found to be the strongest independent predictor of incomplete revascularization in patients with complex coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs). It was associated with higher rates of 4-year mortality and major adverse cardiac and cerebrovascular events (MACCEs) in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial [3]. The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function
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