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Updated: May 13, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy
Michael Megaly1, Samer Zakhour2, Mohamed Maki3
1Department of Cardiology, Ascension St John Heart and Vascular Institute, Tulsa, Oklahoma.
Insights
Percutaneous coronary intervention for chronic total occlusions in the left circumflex or right coronary arteries significantly improves heart function in heart failure patients. This procedure enhanced left ventricular ejection fraction by 8.2% over two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- Heart failure with reduced ejection fraction (HFrEF) significantly impacts cardiovascular health.
- Chronic total occlusions (CTOs) in non-left anterior descending coronary arteries (non-LAD) present unique challenges in HFrEF management.
- The impact of percutaneous coronary intervention (PCI) for CTOs in the left circumflex artery (LCX) or right coronary artery (RCA) on left ventricular ejection fraction (LVEF) in HFrEF patients is not well-established.
Purpose of the Study:
- To evaluate the efficacy of LCX or RCA CTO PCI in improving LVEF in patients with HFrEF.
- To assess the impact of CTO PCI on major adverse cardiovascular events (MACE) in this patient population.
- To explore the influence of myocardial viability testing and optimal heart failure therapy (OHFT) on LVEF outcomes after CTO PCI.
Main Methods:
- Retrospective analysis of 111 HFrEF patients (LVEF <40%) undergoing LCX or dominant RCA CTO PCI.
- Primary outcome: change in LVEF.
- Secondary outcomes: in-hospital and long-term MACE; subgroup analyses on viability testing and OHFT.
Main Results:
- Successful non-LAD CTO PCI achieved a technical success rate of 93.6% with a 5.4% in-hospital MACE rate.
- A significant LVEF improvement of 8.2% was observed at a median follow-up of 27.4 months (p <0.001).
- RCA CTO PCI resulted in a 9.6% LVEF increase (p <0.001), while LCX PCI showed a 5.6% improvement (p = 0.011). Preprocedure viability testing and postprocedural OHFT did not significantly influence LVEF changes.
Conclusions:
- Non-LAD CTO PCI significantly enhances LVEF in HFrEF patients over a two-year period.
- The benefits of CTO PCI on LVEF are observed irrespective of pre-procedure myocardial viability assessment or adherence to optimal medical therapy.
- CTO PCI represents a viable therapeutic option for improving cardiac function in select HFrEF patients with complex coronary artery disease.
Abstract:
To evaluate the impact of left circumflex artery (LCX) or right coronary artery (RCA) chronic total occlusion percutaneous coronary intervention (CTO PCI) on left ventricular ejection fraction (LVEF) in heart failure patients with reduced ejection fraction (HFrEF). The effect of RCA or LCX CTO PCI on HFrEF patients remains understudied. We conducted a retrospective analysis of patients with HFrEF (EF <40%) who underwent LCX or dominant RCA CTO PCI at a high-volume center. The primary outcome was LVEF change, while secondary outcomes included in-hospital and long-term major adverse cardiovascular events (MACE). Subgroup analyses assessed the influence of myocardial viability testing and optimal heart failure therapy (OHFT) on LVEF change. From December 2014 to February 2022, 111 HFrEF patients underwent non-LAD CTO PCI, with a 93.6% technical success rate and 5.4% in-hospital MACE rate. At a median 27.4-month follow-up, LVEF significantly improved by 8.2% (95% CI 5.9% to 10.7%, p <0.001). RCA CTO PCI led to a 9.6% LVEF increase (95% CI 6.7% to 12.6%, p <0.001), while LCX PCI resulted in a 5.6% improvement (95% CI 1.3% to 9.8%, p = 0.011). Preprocedure viability testing (p = 0.310) and postprocedural OHFT (defined as three classes of guideline-directed medical therapy, p = 0.673) were not significantly associated with LVEF changes. Non-LAD CTO PCI significantly improved LVEF (8.2%) in HFrEF patients over 2 years, regardless of preprocedure viability testing or postprocedural medical therapy.
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