Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery
Michael Megaly1, Samer Zakhour1, Judit Karacsonyi2
1Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
Insights
Percutaneous coronary intervention for left anterior descending chronic total occlusion (LAD CTO PCI) shows high success and survival rates. LAD CTO PCI significantly improves heart function in patients with ischemic cardiomyopathy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The left anterior descending artery (LAD) supplies a large portion of the heart muscle.
- Outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in the LAD are not well-established.
- Chronic total occlusions in the LAD pose a significant challenge in cardiovascular interventions.
Purpose of the Study:
- To evaluate the clinical outcomes and impact on left ventricular ejection fraction (LVEF) following LAD CTO PCI.
- To compare outcomes between patients with and without ischemic cardiomyopathy.
- To assess the effectiveness of LAD CTO PCI in a high-volume single center setting.
Main Methods:
- Retrospective analysis of 237 patients undergoing LAD CTO PCI from December 2014 to February 2021.
- Assessment of in-hospital and long-term major adverse cardiovascular events (MACEs).
- Subgroup analysis of patients with ischemic cardiomyopathy (LVEF ≤ 40%) and changes in LVEF post-procedure.
Main Results:
- Technical success rate of 97.4% with an in-hospital MACE rate of 5.4%.
- Two-year overall survival was 92%, and MACE-free survival was 85%.
- Significant LVEF improvement (10.9% at 9 months) observed in patients with ischemic cardiomyopathy, particularly with proximal occlusions and optimal medical therapy.
Conclusions:
- LAD CTO PCI is associated with high technical success and favorable long-term survival (92% at 2 years) in a high-volume center.
- No significant difference in survival was noted between patients with or without ischemic cardiomyopathy.
- LAD CTO PCI offers significant functional improvement in LVEF for patients suffering from ischemic cardiomyopathy.
Abstract:
The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center. Outcomes included in-hospital and long-term major adverse cardiovascular events (MACEs) and changes in left ventricular ejection fraction (LVEF). We performed a subgroup analysis of patients with ischemic cardiomyopathy, defined as an LVEF of 40% or less. From December 2014 to February 2021, 237 patients underwent LAD CTO PCI. The technical success rate was 97.4%, and the in-hospital MACE rate was 5.4%, A landmark analysis after hospital discharge showed an overall survival of 92% and 85% MACE-free survival at 2 years. There was no difference in overall survival or MACE-free survival between those who had ischemic cardiomyopathy versus those who did not. In patients with ischemic cardiomyopathy, LAD CTO PCI was associated with significant improvement in LVEF (10.9% at 9 months), which was further pronounced when these patients had a proximal LAD CTO and were on optimal medical therapy (14% at 6 months). In a single high-volume center, LAD CTO PCI was associated with 92% overall survival at 2 years, with no difference in survival between patients with or without ischemic cardiomyopathy. LAD CTO PCI was associated with an absolute 10% increase in LVEF at 9 months in patients with ischemic cardiomyopathy.
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