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Association Between Optimal Revascularization for Chronic Total Occlusion and Long-Term Outcomes in Patients With
Yanjun Song1,2, Zhangyu Lin1,2, Jining He1,2
1Cardiometabolic Medicine Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Journal of the American Heart Association
|July 10, 2026
Summary
Optimal revascularization in chronic total occlusion percutaneous coronary intervention (CTO-PCI) significantly reduces adverse cardiovascular events in heart failure patients, especially those with type 2 diabetes (T2D). This finding highlights the importance of achieving optimal CTO-PCI outcomes for improved long-term prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- The clinical impact of optimal revascularization for chronic total occlusion (CTO) lesions on long-term outcomes in heart failure patients, with or without type 2 diabetes (T2D), is not well-established.
- This study addresses the knowledge gap regarding the association between CTO percutaneous coronary intervention (CTO-PCI) success and long-term adverse clinical events in this specific patient population.
Purpose of the Study:
- To investigate the relationship between optimal versus non-optimal CTO-PCI outcomes and long-term adverse clinical events.
- To specifically evaluate these associations in patients with heart failure, considering the presence or absence of type 2 diabetes.
Main Methods:
- A prospective cohort study involving 1591 heart failure patients who underwent CTO-PCI between January 2017 and December 2018.
- Patients were stratified into three groups based on CTO-PCI results: failure, suboptimal revascularization, and optimal revascularization.
- Primary endpoint: composite of cardiovascular death and target-vessel myocardial infarction (TVMI). Secondary endpoint: composite of all-cause death and myocardial infarction.
Main Results:
- Over a median follow-up of 3.3 years, optimal revascularization was associated with significantly lower risks of both cardiovascular death/TVMI (HR, 0.45) and all-cause death/myocardial infarction (HR, 0.53) compared to CTO-PCI failure.
- Subgroup analysis revealed these benefits were particularly pronounced in patients with T2D (cardiovascular death/TVMI: HR, 0.25; all-cause death/MI: HR, 0.28).
- No significant association was observed between optimal revascularization and outcomes in patients without T2D.
Conclusions:
- Optimal revascularization achieved during CTO-PCI is linked to reduced long-term adverse cardiovascular events in patients with heart failure.
- The benefit of optimal CTO-PCI appears particularly significant for heart failure patients who also have type 2 diabetes.
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