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Effect of percutaneous coronary intervention for chronic total occlusion on diastolic atrioventricular coupling in

Casper F Coerkamp1, Mark J Hinderks2, Joëlle Elias1

  • 1Department of Cardiology, Heart Centre, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

International Journal of Cardiology
|January 10, 2026
PubMed

Insights

Percutaneous coronary intervention for chronic total occlusion did not improve the left atrioventricular coupling index (LACI) in STEMI patients. However, an elevated LACI independently predicted long-term mortality, highlighting its prognostic value.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has not improved left ventricular systolic function.
  • Left atrioventricular coupling index (LACI), derived from cardiovascular magnetic resonance (CMR), assesses diastolic dysfunction and prognosis post-myocardial infarction.
  • The study investigates LACI's role in ST-elevation myocardial infarction (STEMI) patients with concurrent CTO.

Purpose of the Study:

  • To evaluate the impact of CTO PCI on LACI in STEMI patients.
  • To determine if CTO PCI influences the change in LACI over time.
  • To assess the prognostic significance of baseline LACI in this patient cohort.

Main Methods:

  • A CMR substudy of the multicentre randomised controlled EXPLORE trial.
  • 200 STEMI patients with CTO underwent baseline CMR; 178 had 4-month follow-up CMR.
  • LACI calculated as the ratio of left atrial to left ventricular end-diastolic volumes.

Main Results:

  • LACI significantly improved over time (P=0.005), irrespective of CTO PCI.
  • CTO PCI did not significantly influence the change in LACI (P=0.122).
  • Baseline LACI ≥20.6% was independently associated with increased all-cause mortality (HR 2.37, P=0.007).

Conclusions:

  • In STEMI patients with concurrent CTO, CTO PCI did not impact LACI at 4 months or its improvement.
  • Elevated LACI early after STEMI is an independent predictor of long-term all-cause mortality.
  • LACI serves as a valuable prognostic marker in STEMI patients with CTO.
Abstract

Keywords:
All-cause mortalityCardiovascular magnetic resonanceChronic total occlusionLeft atrioventricular coupling indexST-elevation myocardial infarction

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