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The myocardium supplied by a chronic total occlusion is a persistently ischemic zone

Rajesh Sachdeva1, Mayank Agrawal, Shawn E Flynn

  • 1WellStar Cardiology, North Fulton Hospital, 3000 Hospital Boulevard, Roswell, Georgia; Department of Internal Medicine, Division of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 25, 2013
PubMed

Insights

Chronic total occlusions (CTOs) in coronary arteries indicate ischemia, even with collateral circulation or left ventricular dysfunction. Percutaneous coronary intervention (PCI) effectively normalizes this ischemia, leading to comparable outcomes to non-CTO patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Myocardial Ischemia

Background:

  • Chronic total occlusions (CTOs) in coronary arteries can be associated with collateral circulation and left ventricular dysfunction.
  • The presence and severity of myocardial ischemia in CTO regions are often underestimated.
  • Fractional flow reserve (FFR) is a key diagnostic tool for assessing ischemia.

Purpose of the Study:

  • To evaluate the presence and severity of myocardial ischemia in patients with CTOs.
  • To compare FFR results in CTO patients with a matched non-CTO control group.
  • To assess the impact of percutaneous coronary intervention (PCI) on ischemia in CTO patients.

Main Methods:

  • A study cohort of 100 patients (50 CTO, 50 controls) undergoing FFR and successful PCI for CTO was evaluated.
  • FFR measurements were compared between CTO and control groups before and after PCI.
  • CTO lesions were characterized by length and stenting requirements.

Main Results:

  • CTO lesions were significantly longer and required more stents compared to controls.
  • Pre-PCI FFR was significantly lower in CTO patients (0.45 ± 0.15) than controls (0.58 ± 0.17).
  • All CTO patients demonstrated an ischemic FFR, with 78% showing resting ischemia, irrespective of collateral development or dysfunction. Post-PCI FFR was similar in both groups (0.91 ± 0.05 vs. 0.90 ± 0.08).

Conclusions:

  • Symptomatic patients with CTOs have an ischemic myocardial territory, even with collateral compensation or left ventricular impairment.
  • PCI can effectively normalize the ischemic zone in CTO patients.
  • Outcomes after PCI for CTO appear comparable to those in non-CTO patients.
Abstract

Keywords:
chronic total occlusionfractional flow reservepercutaneous coronary interventionstenting

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