Differential clinical impact of chronic total occlusion revascularization based on left ventricular systolic function
Hyungdon Kook1, Jeong Hoon Yang2, Jae Young Cho3
1Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, #73, Goryeodae-ro, Sungbuk-ku, Seoul, 02841, Korea.
Insights
Successful chronic total occlusion revascularization improves survival for all patients. The survival benefit of revascularization is greater and more pronounced over time in patients with reduced left ventricular systolic function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- The survival benefit of chronic total occlusion (CTO) revascularization is debated.
- Limited data exist on CTO revascularization outcomes stratified by left ventricular systolic function (LVSF).
- This study assesses differential outcomes of CTO revascularization in patients with preserved LVSF (PLVSF) versus reduced LVSF (RLVSF).
Purpose of the Study:
- To compare clinical outcomes between successful CTO revascularization (SCR) and optimal medical therapy (OMT) in patients with PLVSF and RLVSF.
- To evaluate the impact of LVSF on the survival benefit of CTO revascularization.
Main Methods:
- A total of 2,173 CTO patients were categorized into PLVSF (EF ≥ 50%) and RLVSF (EF < 50%) groups.
- Clinical outcomes were compared between SCR and OMT within each LVSF group.
- Inverse probability of treatment weighting and contrast tests were used for endpoint and survival probability analyses.
Main Results:
- SCR was associated with significantly lower primary endpoint incidence (all-cause death or non-fatal MI) compared to OMT in both RLVSF and PLVSF groups.
- The survival benefit of SCR was greater and became more pronounced over time in RLVSF patients compared to PLVSF patients.
- The reduction in cardiac death was a primary driver of the improved survival in the SCR group.
Conclusions:
- Successful CTO revascularization offers a survival benefit over OMT, irrespective of LVSF.
- The survival advantage of SCR is more substantial and increases over time in patients with reduced LVSF compared to those with preserved LVSF.
Background:
The effect of chronic total occlusion (CTO) revascularization on survival remains controversial. Furthermore, data regarding outcome differences for CTO revascularization based on left ventricular systolic function (LVSF) are limited. The differential outcomes from CTO revascularization in patients with preserved LVSF (PLVSF) versus reduced LVSF (RLVSF) were assessed.
Methods:
A total of 2,173 CTO patients were divided into either a PLVSF (n = 1661, Ejection fraction ≥ 50%) or RLVSF (n = 512, < 50%) group. Clinical outcomes were compared between successful CTO revascularization (SCR) versus optimal medical therapy (OMT) within each group. The primary endpoint was a composite of all-cause death or non-fatal myocardial infarction. Inverse probability of treatment weighting for endpoint analysis and a contrast test for comparison of survival probability differences according to LVSF were used.
Results:
Patients with RLVSF had a mean 37% ejection fraction (EF) and 19% had EF < 30%. The median follow-up duration was 1,138 days. Regardless of LVSF, the primary endpoint incidence was significantly lower in patients treated with SCR [RLVSF: 29.7% vs. 49.7%, hazard ratio (HR) = 0.46, 95% confidence interval (CI): 0.36-0.62, p < 0.0001; PLVSF 7.3% vs. 16.9%, HR = 0.68, 95% CI: 0.54-0.93, p = 0.0019], which was mainly driven by a reduction in cardiac death. The difference in survival probability was greater and became more pronounced over time in patients with RLVSF than with PLVSF (1-year, p = 0.197; 3-years, p = 0.048; 5-years, p = 0.036).
Conclusions:
SCR was associated with better survival benefit than OMT regardless of LVSF. The benefit was greater and became more significant over time in patients with RLVSF versus PLVSF.
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