Long-Term Clinical Outcomes of Successful Chronic Total Occlusion Revascularization in Patients With Reduced Left Ventricular Ejection Fraction

초록

Background The benefits of revascularization in chronic total occlusion (CTO) patients with reduced left ventricular ejection fraction (LVEF) still remain conflicting. The aim of this study is to investigate the clinical impact of CTO revascularization in patients with reduced LVEF compared with those receiving medical treatment (MT). Methods A total of 369 consecutive patients who were diagnosed with CTO by coronary angiography were allocated to either the group medical treatment (MT, n = 204) group or percutaneous coronary intervention (PCI, n = 165) according to treatment strategies. The 5-year clinical outcomes were compared between the two groups. Primary endpoint was a cardiac death or a target vessel revascularization (TVR) for CTO lesion. Results After Inverse probability weighting (IPTW)analysis, the pseudo sample size in the MT group and PCI group was 364 and 370, respectively. After a median 6.0 years follow-up period (interquartile range: 5.0 to 8.1 years), the incidence of cardiac death (9.0% vs. 4.5%, P=0.019) and cardiac death under heart failure hospitalization (3.8% vs. 1.0%, P=0.017) were higher in MT group, but the incidence of TVR for CTO lesion was higher in PCI group (11.5%vs. 22.7%, P<0.001). Based on logistic regression analysis, patients with CTO revascularization had survival benefits for cardiac death (HR: 0.558 [95% CI: 0.327-0.953]) and cardiac death after heart failure hospitalization (HR: 0.403 [95% CI: 0.164-0.990]). Conclusion In our study, in patients with LV systole dysfunction (EF < 50%), successful CTO revascularization is related to long-term survival benefits. These results suggest that a successful CTO revascularization is associated with a reduction in cardiac death after heart failure hospitalization.