Retrograde percutaneous coronary intervention for chronic total occlusions in patients with reduced left ventricular
Song Wen1, Chang Dai1,2, Zehan Huang1
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
Insights
Retrograde percutaneous coronary intervention (PCI) is safe for patients with low left ventricular ejection fraction (LVEF) and chronic total occlusion (CTO). Successful CTO recanalization improves survival, irrespective of LVEF.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Safety and prognostic implications of retrograde PCI in patients with low LVEF and CTO remain unclear.
- This study assesses retrograde CTO PCI in patients with reduced LVEF (≤40%).
Purpose of the Study:
- To evaluate the procedural success and long-term outcomes of retrograde CTO PCI in patients with reduced LVEF.
- To compare outcomes between patients with reduced and preserved LVEF.
Main Methods:
- Retrospective analysis of 836 patients undergoing elective retrograde CTO PCI.
- Comparison of patient and lesion characteristics, procedural details, and long-term outcomes between LVEF groups (≤40% vs. >40%).
Main Results:
- High collateral channel tracking (93.5%), retrograde technical success (87.8%), and recanalization success (87.8%) were observed.
- Patients with LVEF ≤40% had higher MACE (23.2%) including all-cause mortality (15.4%) and cardiac death (12.2%).
- Reduced LVEF (≤40%) and age were independent predictors of MACE, while revascularization success was protective.
Conclusions:
- Retrograde PCI is a safe and effective strategy for patients with reduced LVEF and CTO.
- Successful CTO recanalization is associated with a significant survival benefit, regardless of LVEF.
Background:
Data on the safety and prognostic implications of retrograde percutaneous coronary intervention (PCI) in patients with low left ventricular ejection fraction (LVEF) and chronic total occlusion (CTO) are unclear. This study aimed to assess the procedural results and long-term outcomes of retrograde CTO PCI in individuals with reduced LVEF (≤ 40%).
Methods:
We conducted a retrospective analysis of 836 consecutive patients who underwent elective retrograde CTO PCI at a single center between January 2011 and April 2023. Patients and lesion characteristics, procedural details and results, and long-term outcomes were compared between patients with reduced (LVEF ≤ 40%) and preserved left ventricular systolic function (LVEF > 40%) based on echocardiographic assessment.
Results:
Baseline LVEF ≤ 40% was presented in 156 (18.7%) patients. The collateral channel (CC) tracking success was high (overall 93.5%) and similar among the groups (94.2% vs. 93.4%, p = 0.835), as well as retrograde technical success (87.8% vs. 89.9%, p = 0.548) and recanalization success (87.8% vs. 91.5%, p = 0.281). Procedure complications were low and similar between the groups (all p > 0.05). Clinical follow-up was available in 767 (91.2%) patients with a medium follow-up of 1041 (531-1511) days. In patients with lower LVEF, the incidence of MACE was higher (23.2% vs. 14.9%, p = 0.021), mainly the all-cause mortality (15.4% vs. 4.1%, p < 0.001) and cardiac death (12.2% vs. 2.5%, p < 0.001). Multivariable analysis revealed that age (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.04, p = 0.008), LVEF ≤ 40% (HR: 1.21, 95%CI: 1.01-1.45, p = 0.039), and revascularization success (HR: 0.38, 95% CI: 0.22-0.66, p < 0.001) were independently associated with MACE.
Conclusions:
Retrograde PCI may represent a safe and efficient management strategy for patients with reduced LVEF and CTO. Furthermore, our study demonstrated that successful CTO recanalization was associated with a significant survival benefit, regardless of left ventricular systolic function.
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