Coronary Chronic Total Occlusions Affect Long-Term Prognosis in Heart Failure With Mildly Reduced Ejection Fraction

Area of Science:

• Cardiology
• Heart Failure Research
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is a primary cause of heart failure with mildly reduced ejection fraction (HFmrEF).
• Data on coronary chronic total occlusions (CTO) in HFmrEF patients are limited.
• CTO prevalence and its prognostic impact in HFmrEF require further investigation.

Purpose of the Study:

• To determine the prevalence of CTO in patients with HFmrEF.
• To assess the prognostic significance of CTO in HFmrEF regarding long-term mortality and adverse events.
• To evaluate the impact of percutaneous coronary intervention (PCI) for CTO on outcomes in HFmrEF.

Main Methods:

• Retrospective analysis of consecutive HFmrEF patients (LVEF 41%-49%) undergoing coronary angiography (2016-2022).
• Comparison of outcomes between patients with and without CTO.
• Risk stratification based on CAD extent and assessment of PCI outcomes.

Main Results:

• Coronary CTO was identified in 17% of HFmrEF patients undergoing angiography.
• CTO was associated with significantly higher rates of all-cause mortality (33% vs. 19%) and major adverse cardiac and cerebrovascular events (MACCE) (60% vs. 32%) at 30 months.
• Successful CTO-PCI correlated with improved long-term survival (21% vs. 38%).

Conclusions:

• Coronary CTO is a common finding in HFmrEF patients.
• CTO presence significantly worsens long-term prognosis in HFmrEF.
• PCI for CTO may offer survival benefits in this patient population.