Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-11 DOI:10.1016/j.amjcard.2025.04.004

Michael Megaly MD, MS , Samer Zakhour MD , Mohamed Maki MD , Linda Albusoul MD , Asaad Nakhle MD , Judit Karacsonyi MD, PhD , Kambis Mashayekhi MD , Stephane Rinfret MD, SM , Emmanouil S. Brilakis MD, PhD , Khaldoon Alaswad MD

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引用次数: 0

Abstract

To evaluate the impact of left circumflex artery (LCX) or right coronary artery (RCA) chronic total occlusion percutaneous coronary intervention (CTO PCI) on left ventricular ejection fraction (LVEF) in heart failure patients with reduced ejection fraction (HFrEF). The effect of RCA or LCX CTO PCI on HFrEF patients remains understudied. We conducted a retrospective analysis of patients with HFrEF (EF <40%) who underwent LCX or dominant RCA CTO PCI at a high-volume center. The primary outcome was LVEF change, while secondary outcomes included in-hospital and long-term major adverse cardiovascular events (MACE). Subgroup analyses assessed the influence of myocardial viability testing and optimal heart failure therapy (OHFT) on LVEF change. From December 2014 to February 2022, 111 HFrEF patients underwent non-LAD CTO PCI, with a 93.6% technical success rate and 5.4% in-hospital MACE rate. At a median 27.4-month follow-up, LVEF significantly improved by 8.2% (95% CI 5.9% to 10.7%, p <0.001). RCA CTO PCI led to a 9.6% LVEF increase (95% CI 6.7% to 12.6%, p <0.001), while LCX PCI resulted in a 5.6% improvement (95% CI 1.3% to 9.8%, p = 0.011). Preprocedure viability testing (p = 0.310) and postprocedural OHFT (defined as three classes of guideline-directed medical therapy, p = 0.673) were not significantly associated with LVEF changes. Non-LAD CTO PCI significantly improved LVEF (8.2%) in HFrEF patients over 2 years, regardless of preprocedure viability testing or postprocedural medical therapy.

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非lad冠状动脉慢性全闭塞PCI对心肌病患者的影响

目的探讨左旋动脉（LCX）或右冠状动脉（RCA）慢性全闭塞经皮冠状动脉介入治疗（CTO PCI）对心力衰竭患者左室射血分数（LVEF）的影响。RCA或LCX CTO PCI对HFrEF患者的影响尚待研究。我们对在大容量中心接受LCX或显性RCA CTO PCI治疗的HFrEF （EF <40%）患者进行了回顾性分析。主要结局是LVEF变化，次要结局包括住院和长期主要不良心血管事件（MACE）。亚组分析评估心肌活力测试和最佳心力衰竭治疗（OHFT）对LVEF变化的影响。2014年12月至2022年2月，111例HFrEF患者行非lad CTO PCI，技术成功率93.6%，住院MACE率5.4%。在中位27.4个月的随访中，LVEF显著改善了8.2% （95% CI 5.9%至10.7%,p <0.001）。RCA CTO PCI导致LVEF增加9.6% (95% CI 6.7%至12.6%,p <0.001)，而LCX PCI导致5.6%的改善（95% CI 1.3%至9.8%,p = 0.011）。术前生存能力测试（p = 0.310）和术后OHFT（定义为三类指南导向的药物治疗，p = 0.673）与LVEF变化无显著相关。非lad CTO PCI在2年内显著改善HFrEF患者的LVEF(8.2%)，无论术前生存能力测试或术后药物治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.