In-hospital and follow-up outcomes after chronic total occlusion percutaneous coronary intervention according to left ventricular ejection fraction: Insights from the PROGRESS-CTO Registry
Nikolakopoulos I, Krestyaninov O, Khelimskii D, Khatri J, Alaswad K, Doing A, Dattilo P, Sheikh AM, Yeh RW, Patel T, Jefferson B, Jaffer FA, Uretsky BF, Love M, Elbarouni B, Koutouzis M, Tsiafoutis I, Choi JW, Vemmou E, Xenogiannis I, Rangan BV, Garcia S, Abdullah S, Banerjee S, Burke MN, and Brilakis ES. In-hospital and follow-up outcomes after chronic total occlusion percutaneous coronary intervention according to left ventricular ejection fraction: Insights from the PROGRESS-CTO Registry. Catheterization and Cardiovascular Interventions 2020; 95:S52-S53.
Catheterization and cardiovascular interventions
Background: Outcomes of chronic total occlusion percutaneous coronary intervention (CTO PCI) according to baseline left ventricular ejection fraction (LVEF) have received limited study.
Methods: We compared clinical, angiographic, procedural characteristics and outcomes of 1,441 CTO PCIs performed in patients with known ejection fraction and available follow-up. We compared patients with LVEF ≥50% (N=834), LVEF 35%-49% (N=434) and LVEF <35% (N=173).
Results: Left anterior descending CTO was significantly more common in the low LVEF group (24% vs 25% vs 42%, p<0.001). The J-CTO score was similar (2.4 ± 1.3 vs 2.5 ± 1.2 vs 2.4 ± 1.2, p = 0.5), as was procedural success (85% vs 83% vs 88%, p = 0.5) with the incidence of in-hospital major adverse cardiovascular events being numerically but not statistically higher in the LVEF<35% group (2% vs 3.5% vs. 4.6%, p = 0.12). The composite endpoint of death, myocardial infarction (MI) and revascularization at 1 year was more common in the LVEF<35% group (13% vs 17% vs 25 %, plog-rank = 0.001) (Figure). There was a significant difference in 1-year mortality (12.8% vs 16.8% vs 24.6%, p < 0.001), but not in MI (1.9% vs 4.4% vs 5.6%, p = 0.07) and revascularization rates (7.4% vs 8.9% vs 10.7%, p = 0.8).
Conclusions: CTO PCI can be performed with high success rates and acceptable in-hospital complication rates irrespectively of LVEF, but patients with LVEF<35% have worse one-year outcomes.