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Efficacy of revascularization in CTO patients based on hibernating myocardium therapy
Wenjie Chen1, Zhiyong Du2, Yanwen Qin2
1Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Hibernating myocardium (HM) assessed by imaging is a key factor in chronic total occlusion (CTO) treatment. For patients with HM/total perfusion defect (TPD) over 38%, percutaneous coronary intervention (PCI) reduces major adverse cardiac events (MACE) compared to optimal medical therapy (OMT).
Area of Science:
- Cardiology
- Nuclear Medicine
- Interventional Cardiology
Background:
- The efficacy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains debated, particularly in patients with ischemic left ventricular dysfunction.
- Assessing hibernating myocardium (HM) using SPECT and 18F-FDG PET is crucial for treatment decisions.
Purpose of the Study:
- To evaluate hibernating myocardium (HM) in patients with CTO and left ventricular dysfunction.
- To compare the clinical outcomes of PCI versus optimal medical therapy (OMT) in this patient cohort.
Main Methods:
- A retrospective analysis of 332 patients with CTO and ischemic left ventricular dysfunction.
- Propensity score matching (PSM) with a 1:2 nearest neighbor algorithm was used to compare PCI and OMT groups.
- The primary endpoint was major adverse cardiac events (MACE), including cardiac death, heart failure readmission, revascularization, and myocardial infarction.
Main Results:
- After PSM, 246 patients were analyzed. Hibernating myocardium/total perfusion defect (HM/TPD) was an independent predictor of MACE (HR: 1.03, p=0.007).
- A HM/TPD cutoff of 38% identified patients at higher risk with OMT (p=0.035).
- Sensitivity analysis confirmed HM/TPD as an independent predictor in single-vessel CTO lesions (HR 1.025, p=0.005).
Conclusions:
- HM/TPD is a significant independent predictor of MACE in CTO patients.
- CTO-PCI offers a lower risk of MACE compared to OMT for patients with HM/TPD >38%.
- Further large-scale studies are warranted to validate these findings.
Background:
The effectiveness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still uncertain, especially for patients with ischemic left ventricular dysfunction. This study aimed to assess hibernating myocardium (HM), as determined by single-photon emission computed tomography (SPECT) and 18F-FDG positron emission tomography (PET), and to compare the benefits of PCI and optimal medical therapy (OMT).
Methods:
A retrospective study collected data from 332 patients with CTO and ischemic left ventricular dysfunction. The study compared patients who underwent PCI or OMT via propensity score matching (PSM) analysis which was performed with a 1:2 matching protocol using the nearest neighbour matching algorithm. The primary endpoint of the study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for worsening heart failure (WHF), revascularization and myocardial infarction (MI).
Results:
After PSM, there were a total of 246 individuals in the PCI and OMT groups. Following Cox regression, hibernating myocardium/total perfusion defect (HM/TPD) was identified as an independent risk factor (hazard ratio (HR): 1.03, 95% confidence interval (CI): 1.008-1.052, p = .007). The cut-off value of HM/TPD was 38%. The results of the subgroup analysis suggest that for patients with HM/TPD >38%, the OMT group had a greater risk of MACE (p = .035). A sensitivity analysis restricting patients with single-vessel CTO lesions, HM/TPD remained an independent predictor (HR 1.025, 95% CI 1.008-1.043, p = .005).
Conclusion:
HM/TPD is an independent predictor of MACE, and for patients with HM/TPD > 38%, CTO-PCI had a lower risk of MACE compared with OMT. However, further validation is still needed through large-scale studies.
