Background: The presence of a chronic total occlusion (CTO) and severe
left ventricular (LV) systolic dysfunction are known negative prognostic factors
in patients with coronary artery disease. Several studies have examined the
effect of CTO revascularization on mortality, symptoms, occurrence of myocardial
infarction (MI), and cardiac function in patients with normal or reduced LV
function. However, the effect of CTO revascularization on heart failure-related
events in patients with LV dysfunction, such as heart failure hospitalization
(HFH), the occurrence of atrial fibrillation (AF), and a worsening renal function
(WRF), has not yet been evaluated. To assess the
success rate and safety of CTO percutaneous coronary interventions (PCIs) in
coronary patients with LV ejection fractions of 40% and evaluate the
impact of successful CTO revascularization on HFH, occurrence of AF, and WRF.
Methods: Prospectively, data were collected from CTO PCIs
performed at three referral centers and analyzed. From a total of 1435 CTO PCIs,
132 (9.2%) patients with a left ventricular ejection fraction (LVEF) of
40% were included in this analysis. The median follow-up duration was
23.18 months (interquartile range (IQR): 11.02–46.66 months). Results: A successful CTO PCI was
achieved in 109 of these patients, while the procedure was unsuccessful in 23
patients (82.5% procedural success rate). Overall, the intervention had an
acceptable number of peri-procedural (or in-hospital) complications (9.1%).
During the follow-up period, the rates of all-cause death, cardiovascular death,
and non-fatal MI were not significantly different between the two groups. The
rates of HFH were significantly lower in the successful PCI group, while WRF and
AF did not differ between successful and unsuccessful PCI groups. Successful PCI
and higher estimated glomerular filtration rate (eGFR) were independent predictors of a lower risk of HFH, while prior
stroke and diabetes were independent predictors of a higher risk of HFH.
Conclusions: In patients with reduced LV systolic function (ejection fraction, EF
40%), CTO PCI is a safe and effective procedure and successful CTO PCI
is independently associated with a lower risk of HFH during follow-up. Further
expansion of this cohort is necessary to confirm these results.
