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Prognosis of Patients With Reduced Left Ventricular Ejection Fraction and Chronic Total Occlusion According to

Kohki Ishida1, Victoria Martin-Yuste1, Susanna Prat1

  • 1Cardiovascular Institute, Interventional Cardiology Section, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|August 11, 2020
PubMed

Insights

Patients with chronic total occlusion (CTO) and reduced ejection fraction (LVEF) fare better with revascularization (CABG or PCI) than medical therapy. Coronary artery bypass grafting (CABG) offers the best long-term outcomes for CTO patients with reduced LVEF.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Chronic total occlusion (CTO) is prevalent in coronary artery disease.
  • Limited research exists on outcomes for CTO patients with reduced left ventricular ejection fraction (LVEF).
  • Treatment strategies for CTO with reduced LVEF require further investigation.

Purpose of the Study:

  • To evaluate the impact of treatment on prognosis in patients with CTO and reduced LVEF.
  • To compare outcomes between medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG).

Main Methods:

  • A cohort of 256 patients with CTO and LVEF <40% was studied.
  • Patients were categorized into three groups: medical therapy (MT), PCI, and CABG.
  • Major adverse cardiac events (MACE), including cardiac mortality and myocardial infarction (MI), were compared.

Main Results:

  • MACE incidence was significantly lower in PCI (20.3%) and CABG (16.7%) groups compared to MT (40%).
  • Both all-cause and cardiac mortality were substantially reduced with revascularization (PCI/CABG) versus MT.
  • Coronary artery bypass graft (CABG) demonstrated the lowest MACE risk in multivariate analysis compared to MT.

Conclusions:

  • Medical therapy is associated with worse prognosis in CTO patients with reduced LVEF compared to revascularization.
  • Both PCI and CABG improve outcomes, with CABG showing the best long-term results.
  • Revascularization strategies are crucial for managing CTO patients with impaired left ventricular function.
Abstract

Keywords:
Coronary artery bypass graftingDrug therapyDrug-eluting stentPercutaneous coronary intervention

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