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Heart Failure-Related Outcomes in Patients with Left Ventricular Dysfunction Undergoing Percutaneous Chronic Total
Pierluigi Lesizza1, Lennert Minten1,2, Ella Poels3
1Department of Cardiovascular Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
Insights
Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with reduced left ventricular ejection fraction (< 40%) lowers heart failure hospitalizations. This safe and effective procedure shows promise for improving outcomes in this high-risk group.
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.
Background:
The presence of a chronic total occlusion (CTO) and severe left ventricular (LV) systolic dysfunction are known negative prognostic factors in patients with coronary artery disease. Several studies have examined the effect of CTO revascularization on mortality, symptoms, occurrence of myocardial infarction (MI), and cardiac function in patients with normal or reduced LV function. However, the effect of CTO revascularization on heart failure-related events in patients with LV dysfunction, such as heart failure hospitalization (HFH), the occurrence of atrial fibrillation (AF), and a worsening renal function (WRF), has not yet been evaluated. To assess the success rate and safety of CTO percutaneous coronary interventions (PCIs) in coronary patients with LV ejection fractions of 40% and evaluate the impact of successful CTO revascularization on HFH, occurrence of AF, and WRF.
Methods:
Prospectively, data were collected from CTO PCIs performed at three referral centers and analyzed. From a total of 1435 CTO PCIs, 132 (9.2%) patients with a left ventricular ejection fraction (LVEF) of 40% were included in this analysis. The median follow-up duration was 23.18 months (interquartile range (IQR): 11.02-46.66 months).
Results:
A successful CTO PCI was achieved in 109 of these patients, while the procedure was unsuccessful in 23 patients (82.5% procedural success rate). Overall, the intervention had an acceptable number of peri-procedural (or in-hospital) complications (9.1%). During the follow-up period, the rates of all-cause death, cardiovascular death, and non-fatal MI were not significantly different between the two groups. The rates of HFH were significantly lower in the successful PCI group, while WRF and AF did not differ between successful and unsuccessful PCI groups. Successful PCI and higher estimated glomerular filtration rate (eGFR) were independent predictors of a lower risk of HFH, while prior stroke and diabetes were independent predictors of a higher risk of HFH.
Conclusions:
In patients with reduced LV systolic function (ejection fraction, EF 40%), CTO PCI is a safe and effective procedure and successful CTO PCI is independently associated with a lower risk of HFH during follow-up. Further expansion of this cohort is necessary to confirm these results.
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