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Updated: May 5, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
PET evaluation of myocardial perfusion function after percutaneous coronary intervention in patients with chronic
Ziyu An1, Jinfan Tian1, Xin Zhao1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Percutaneous coronary intervention (PCI) significantly improves myocardial blood flow and coronary flow reserve in chronic total occlusion (CTO) territories and remote areas. This suggests widespread perfusion recovery after PCI, benefiting patients with CTO and high ischemic burdens.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nuclear Cardiology
Background:
- The clinical benefit of percutaneous coronary intervention (PCI) for chronic total coronary artery occlusion (CTO) is debated.
- PCI is typically reserved for symptom relief and myocardial ischemia reduction.
- Large CTOs with extensive myocardial territories may represent a group that benefits most from revascularization.
Purpose of the Study:
- To evaluate and compare myocardial perfusion in CTO territories and remote areas before and after PCI.
- To assess the impact of PCI on myocardial blood flow (MBF) and coronary flow reserve (CFR) using positron emission tomography (PET).
Main Methods:
- A systematic literature search was conducted in Cochrane Library and PubMed for studies published before November 28, 2022.
- Meta-analysis of five studies (2017-2022, 592 patients) was performed.
- Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for myocardial perfusion parameters.
Main Results:
- PCI significantly increased stress MBF in CTO territories (MD: 1.70, 95% CI: 1.33-2.08, p<0.001).
- Coronary flow reserve (CFR) in CTO regions also improved post-PCI (MD: 1.37, 95% CI: 1.13-1.61, p<0.001).
- Stress MBF and CFR in remote regions also showed significant increases after PCI (p=0.004 and p=0.001, respectively).
Conclusions:
- PCI leads to significant improvements in stress MBF and CFR in both CTO and remote myocardial regions.
- These findings indicate substantial recovery of blood perfusion following PCI in patients with CTO.
- CTO-PCI is beneficial for patients with CTO arteries and significant ischemic burdens.
Abstract:
Objective. The benefit of percutaneous coronary intervention (PCI) in chronic complete coronary artery occlusion (CTO) remains controversial. PCI is currently indicated only for symptom and myocardial ischemia abolition, but large chronically occluded vessels with extensive afferent myocardial territories may benefit most from this procedure. The noninvasive evaluation of myocardial perfusion is critical before and after revascularization, and positron emission tomography (PET) can determine absolute myocardial perfusion. Here, we aimed to explore and compare myocardial perfusion in CTO territories and their remote associated areas before and after PCI. Design. We searched for relevant articles published before November 28, 2022, in the Cochrane Library and PubMed. We calculated 95% confidence intervals (CIs) and standardized mean differences (SMDs) for parameters related to myocardial perfusion in CTO territories and remote areas in CTO patients before and after PCI. Results. We included five studies published between 2017 and 2022, with a total of 592 patients. Stress myocardial blood flow (MBF) was increased in CTO territories after PCI when compared to pre-PCI (mean difference [MD]: 1.70, 95% confidence interval [CI] 1.33-2.08, p < 0.001). Coronary flow reserve (CFR) in CTO regions was also higher after PCI (MD 1.37,95% [CI]1.13-1.61, p < 0.001). Stress MBF in remote regions was also increased after PCI (MD 0.27,95% [CI]0.99 ∼ 0.45, p = 0.004), as was CFR in remote regions (MD 0.32,95% [CI] 0.14-0.5, p = 0.001). Conclusions. According to our pooled analysis of current literature, there was an increase in stress MBF and CFR in both CTOs and remote regions after PCI, suggesting that patients with CTO have widespread recovery of blood perfusion after the procedure. These results provide evidence that patients with CTO arteries and high ischemic burdens would indeed benefit from CTO-PCI. Future research on the correlation of ischemia burden reduction with hard clinical endpoints would contribute to a clearer demarcation of the role of CTO PCI with prognostic potential.
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