Heart Failure-Related Outcomes in Patients with Left Ventricular Dysfunction Undergoing Percutaneous Chronic Total Occlusion Revascularization

Pierluigi Lesizza; Lennert Minten; Ella Poels; Maarten Vanhaverbeke; Gianluca Castaldi; Keir McCutcheon; Daan Cottens; Carlo Zivelonghi; Pierfrancesco Agostoni; Christophe Dubois; Jo Dens; Johan Bennett

doi:10.31083/j.rcm2412345

Heart Failure-Related Outcomes in Patients with Left Ventricular Dysfunction Undergoing Percutaneous Chronic Total Occlusion Revascularization

Rev Cardiovasc Med. 2023 Dec 12;24(12):345. doi: 10.31083/j.rcm2412345. eCollection 2023 Dec.

Authors

Pierluigi Lesizza¹, Lennert Minten^{1

2}, Ella Poels³, Maarten Vanhaverbeke^{1

4}, Gianluca Castaldi⁵, Keir McCutcheon², Daan Cottens³, Carlo Zivelonghi⁵, Pierfrancesco Agostoni⁵, Christophe Dubois^{1

2}, Jo Dens³, Johan Bennett^{1

2}

Affiliations

¹ Department of Cardiovascular Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
² Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium.
³ Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium.
⁴ Department of Cardiology, AZ Delta, 8800 Roeselare, Belgium.
⁵ HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, 2060 Antwerp, Belgium.

Abstract

Background: The presence of a chronic total occlusion (CTO) and severe left ventricular (LV) systolic dysfunction are known negative prognostic factors in patients with coronary artery disease. Several studies have examined the effect of CTO revascularization on mortality, symptoms, occurrence of myocardial infarction (MI), and cardiac function in patients with normal or reduced LV function. However, the effect of CTO revascularization on heart failure-related events in patients with LV dysfunction, such as heart failure hospitalization (HFH), the occurrence of atrial fibrillation (AF), and a worsening renal function (WRF), has not yet been evaluated. To assess the success rate and safety of CTO percutaneous coronary interventions (PCIs) in coronary patients with LV ejection fractions of $\leq$ 40% and evaluate the impact of successful CTO revascularization on HFH, occurrence of AF, and WRF.

Methods: Prospectively, data were collected from CTO PCIs performed at three referral centers and analyzed. From a total of 1435 CTO PCIs, 132 (9.2%) patients with a left ventricular ejection fraction (LVEF) of $\leq$ 40% were included in this analysis. The median follow-up duration was 23.18 months (interquartile range (IQR): 11.02-46.66 months).

Results: A successful CTO PCI was achieved in 109 of these patients, while the procedure was unsuccessful in 23 patients (82.5% procedural success rate). Overall, the intervention had an acceptable number of peri-procedural (or in-hospital) complications (9.1%). During the follow-up period, the rates of all-cause death, cardiovascular death, and non-fatal MI were not significantly different between the two groups. The rates of HFH were significantly lower in the successful PCI group, while WRF and AF did not differ between successful and unsuccessful PCI groups. Successful PCI and higher estimated glomerular filtration rate (eGFR) were independent predictors of a lower risk of HFH, while prior stroke and diabetes were independent predictors of a higher risk of HFH.

Conclusions: In patients with reduced LV systolic function (ejection fraction, EF $\leq$ 40%), CTO PCI is a safe and effective procedure and successful CTO PCI is independently associated with a lower risk of HFH during follow-up. Further expansion of this cohort is necessary to confirm these results.

Keywords: CTO PCI; LV dysfunction; heart failure.