Heart Failure-Related Outcomes in Patients with Left Ventricular Dysfunction Undergoing Percutaneous Chronic Total...

Area of Science:

• Cardiology
• Interventional Cardiology
• Heart Failure Management

Background:

• Chronic total occlusion (CTO) and severe left ventricular (LV) systolic dysfunction are poor prognostic indicators in coronary artery disease.
• Previous studies focused on CTO revascularization's impact on mortality and cardiac function, but not specifically on heart failure events in patients with LV dysfunction.

Purpose of the Study:

• To assess the success rate and safety of CTO percutaneous coronary interventions (PCIs) in patients with LV ejection fraction < 40%.
• To evaluate the impact of successful CTO PCI on heart failure hospitalization (HFH), atrial fibrillation (AF), and worsening renal function (WRF).

Main Methods:

• A prospective analysis of CTO PCIs performed at three referral centers.
• Inclusion criteria: 132 patients with LV ejection fraction < 40% from a total of 1435 CTO PCIs.
• Median follow-up of 23.18 months.

Main Results:

• 82.5% procedural success rate for CTO PCI with acceptable peri-procedural complications (9.1%).
• Successful CTO PCI was associated with significantly lower rates of heart failure hospitalization (HFH).
• No significant differences in all-cause death, cardiovascular death, non-fatal MI, WRF, or AF between successful and unsuccessful PCI groups. Higher eGFR and successful PCI predicted lower HFH risk.

Conclusions:

• CTO PCI is safe and effective in patients with reduced LV systolic function (EF < 40%).
• Successful CTO PCI is independently linked to a reduced risk of HFH during follow-up.
• Further research is needed to confirm these findings in a larger cohort.