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

Giuseppe Pinto, Gabriele Fragasso, Marco Gemma, Letizia Bertoldi, Anna Salerno, Cosmo Godino MD, Antonio Colombo, Lorenzo Azzalini, Alberto Margonato, Mauro Carlino

Research output: Contribution to journalArticlepeer-review

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 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.

Original languageEnglish
Pages (from-to)831-838
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume96
Issue number4
DOIs
Publication statusPublished - Oct 1 2020

Keywords

  • cardiac mortality
  • chronic total occlusions
  • heart failure
  • revascularization
  • total mortality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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