Megaly M, Zakhour S, Karacsonyi J, Basir M, Kunkel K, Simsek B, Kostantinis S, Mashayekhi K, Kandzari D, Brilakis E, and Alaswad K. TCT-126 Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery. J Am Coll Cardiol 2022; 80(12):B52.
J Am Coll Cardiol
Background: Improvement of left ventricular ejection fraction (LVEF) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been modest in prior studies.
Methods: Our cohort included patients who underwent LAD CTO PCI at a single center (Henry Ford Hospital) from 2014 to 2021. We evaluate the change in LVEF after LAD CTO PCI using the paired t test in all patients, those with ischemic cardiomyopathy (CM), and those who underwent a viability test.
Results: From December 2014 to February 2022, a total of 237 LAD CTO PCI procedures were performed at Henry Ford Hospital (proximal LAD: 56.6%). In-hospital MACE occurred in 13 patients (5.5%; death: 1.3%). Landmark analysis after discharge showed an overall survival of the cohort was 92.7% and MACE-free survival of 85.0% over a median follow-up of 2 years. The median baseline EF was 50% (IQR 35%-55%). Only 51 patients had reduced baseline LVEF (40% or less). After a median follow-up of 9.2 months (IQR 3-28.6 months), there was a significant improvement in LVEF after LAD CTO PCI (mean 10.9%, 95% CI 7.1%-14.8%, P < 0.001). When limiting the analysis to patients who had ischemic cardiomyopathy, proximal LAD CTO PCI, and were on optimal medical therapy (n = 29), LVEF was significantly improved (mean increase of 14%, 95% CI 9.5-18.5%, P < 0.001) after a median follow-up period of 6.2 months (3-29.5 months).
Conclusion: LAD CTO PCI was associated with a significant 10% improvement in LVEF in ICM patients and was more pronounced (14% improvement) in those who had proximal LAD treated and were on optimal medical therapy.
Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)