OBJECTIVES: The authors sought to evaluate the impact of ischemic burden reduction after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on long-term prognosis and cardiac symptom relief. BACKGROUND: The clinical benefit of CTO PCI is questioned. METHODS: In a high-volume CTO PCI center, 212 patients prospectively underwent quantitative [15O]H2O positron emission tomography perfusion imaging before and three months after successful CTO PCI between 2013-2019. Perfusion defects (PD) (in segments) and hyperemic myocardial blood flow (hMBF) (in ml · min-1 · g-1) allocated to CTO areas were related to prognostic outcomes using unadjusted (Kaplan-Meier curves, log-rank test) and risk-adjusted (multivariable Cox regression) analyses. The prognostic endpoint was a composite of all-cause death and nonfatal myocardial infarction. RESULTS: After a median [interquartile range] of 2.8 years [1.8 to 4.3 years], event-free survival was superior in patients with ≥3 versus <3 segment PD reduction (p < 0.01; risk-adjusted p = 0.04; hazard ratio [HR]: 0.34 [95% confidence interval (CI): 0.13 to 0.93]) and with hMBF increase above (Δ≥1.11 ml · min-1 · g-1) versus below the population median (p < 0.01; risk-adjusted p < 0.01; HR: 0.16 [95% CI: 0.05 to 0.54]) after CTO PCI. Furthermore, event-free survival was superior in patients without versus any residual PD (p < 0.01; risk-adjusted p = 0.02; HR: 0.22 [95% CI: 0.06 to 0.76]) or with a residual hMBF level >2.3 versus ≤2.3 ml · min-1 · g-1 (p < 0.01; risk-adjusted p = 0.03; HR: 0.25 [95% CI: 0.07 to 0.91]) at follow-up positron emission tomography. Patients with residual hMBF >2.3 ml · min-1 · g-1 were more frequently free of angina and dyspnea on exertion at long-term follow-up (p = 0.04). CONCLUSIONS: Patients with extensive ischemic burden reduction and no residual ischemia after CTO PCI had lower rates of all-cause death and nonfatal myocardial infarction. Long-term cardiac symptom relief was associated with normalization of hMBF levels after CTO PCI.
OBJECTIVES: The authors sought to evaluate the impact of ischemic burden reduction after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on long-term prognosis and cardiac symptom relief. BACKGROUND: The clinical benefit of CTO PCI is questioned. METHODS: In a high-volume CTO PCI center, 212 patients prospectively underwent quantitative [15O]H2O positron emission tomography perfusion imaging before and three months after successful CTO PCI between 2013-2019. Perfusion defects (PD) (in segments) and hyperemic myocardial blood flow (hMBF) (in ml · min-1 · g-1) allocated to CTO areas were related to prognostic outcomes using unadjusted (Kaplan-Meier curves, log-rank test) and risk-adjusted (multivariable Cox regression) analyses. The prognostic endpoint was a composite of all-cause death and nonfatal myocardial infarction. RESULTS: After a median [interquartile range] of 2.8 years [1.8 to 4.3 years], event-free survival was superior in patients with ≥3 versus <3 segment PD reduction (p < 0.01; risk-adjusted p = 0.04; hazard ratio [HR]: 0.34 [95% confidence interval (CI): 0.13 to 0.93]) and with hMBF increase above (Δ≥1.11 ml · min-1 · g-1) versus below the population median (p < 0.01; risk-adjusted p < 0.01; HR: 0.16 [95% CI: 0.05 to 0.54]) after CTO PCI. Furthermore, event-free survival was superior in patients without versus any residual PD (p < 0.01; risk-adjusted p = 0.02; HR: 0.22 [95% CI: 0.06 to 0.76]) or with a residual hMBF level >2.3 versus ≤2.3 ml · min-1 · g-1 (p < 0.01; risk-adjusted p = 0.03; HR: 0.25 [95% CI: 0.07 to 0.91]) at follow-up positron emission tomography. Patients with residual hMBF >2.3 ml · min-1 · g-1 were more frequently free of angina and dyspnea on exertion at long-term follow-up (p = 0.04). CONCLUSIONS: Patients with extensive ischemic burden reduction and no residual ischemia after CTO PCI had lower rates of all-cause death and nonfatal myocardial infarction. Long-term cardiac symptom relief was associated with normalization of hMBF levels after CTO PCI.
Authors: Eleonora Melotti; Marta Belmonte; Carlo Gigante; Vincenzo Mallia; Saima Mushtaq; Edoardo Conte; Danilo Neglia; Gianluca Pontone; Carlos Collet; Jeroen Sonck; Luca Grancini; Antonio L Bartorelli; Daniele Andreini Journal: Front Cardiovasc Med Date: 2022-05-02
Authors: Adrian P Banning; Patrick Serruys; Giovanni Luigi De Maria; Nicola Ryan; Simon Walsh; Nieves Gonzalo; Robert Jan van Geuns; Yoshinobu Onuma; Manel Sabate; Justin Davies; Maciej Lesiak; Raul Moreno; Ignacio Cruz-Gonzalez; Stephen P Hoole; Jan J Piek; Clare Appleby; Farzin Fath-Ordoubadi; Azfar Zaman; Nicolas M Van Mieghem; Neal Uren; Javier Zueco; Pawel Buszman; Andres Iniguez; Javier Goicolea; David Hildick-Smith; Andrzej Ochala; Dariusz Dudek; Ton de Vries; David Taggart; Vasim Farooq; Ernest Spitzer; Jan Tijssen; Javier Escaned Journal: Eur Heart J Date: 2022-03-31 Impact factor: 29.983