Author + information
- Alfredo Galassi1,
- Marouane Boukhris2,
- zied Belhadj3,
- Lobna Laaroussi4,
- Islam Ghanem5,
- Davide Tomasello6,
- Aurel Toma7,
- Oliver Gaemperli8,
- Thomas Luscher9 and
- Kambis Mashayekhi10
- 1University of Catania, Catania, Italy
- 2Abderrahmen Mami Hospital, Ben Arous, Tunisia
- 3Abderrahmen Mami hospital, ariana, Tunisia
- 4Abderrahemen Mami Hospital, Ariana, Tunisia
- 5Deutsches Herzzentrum München, Technische Universität München
- 6Cannizzaro Hospital, Catania, Italy
- 7university Freiburg-Bad Krozingen, Staufen, Germany
- 8University Hospital Zurich, Zurich, Switzerland
- 9CardiologyUniversity Heart Center, Zurich, Switzerland
- 10University Heartcenter Bad Krozingen, Bad Krozingen, Germany
The prognostic value of left ventricular ejection fraction (LVEF) is well established in patients with coronary artery disease. Data regarding patients with low EF affected by chronic total occlusions (CTOs) are scarcely reported.
We performed a multicenter prospective study enrolling 839 CTO patients attempted percutaneously between January 2013 and December 2015. Patients were subdivided into 3 groups according to LVEF : group 1 (LVEF>50%), group 2 (LVEF 35-50%) and group 3 (LVEF<35%). Baseline clinical and angiographic characteristics, procedural details, success rate and in-hospital outcome were compared between groups. J-CTO score was used to assess CTO lesion complexity. In CTO patients with LVEF<35% successfully revascularized, clinical follow-up was performed. Major adverse cardiac and cardiovascular events (MACCE) were defined as the composite of cardiac death, myocardial infarction (MI) and target vessel revascularization. Angiographic follow-up was performed either systematically or driven by ischemia.
The mean age was 64.6±10.5 years and 87.7% were males. According to LVEF, patients were subdivided as follows: group 1 (n=552 [65.8%]), group 2 (n=215 [25.6%]) and group 3 (n=72 [8.6%]). Group 3 patients were older, had more comorbidies (diabetes, dyslipidemia, peripheral artery disease and chronic kidney disease), and showed more often three-vessel disease (58.3% vs. 38.2%; p=0.007). As compared to group 2, group 3 patients were more often diabetic with less prior PCI (23.6% vs. 33.7%; p=0.022). No difference in J-CTO score was observed between the three groups. Similar success rates were obtained in the three groups (93.5% vs. 94.4% vs. 91.7%, respectively). Lower contrast load was used in group 3 in comparison with group 1 and group 2 (295.6±159 ml vs. 369.9±213.9 ml [p=0.005] and vs. 349.1±197.7 ml [p=0.038]). The in-hospital outcome was similar between groups, and no death, MI or emergency need for cardiac surgery was observed in patients with LVEF<35%. Among patients with LVEF<35% successfully revascularized, a mean follow-up period of 17.6±10.2 months was performed. A significant improvement in LVEF (+11.5±7.3%; p<0.001) was observed. At 2 years, MACCE free survival was 77.9%. Angiographic follow-up was performed in 49 (74.2%) patients with LVEF <35%: target CTO vessel restenosis was found in 4 patients (8.2%) (focal in all cases), while no reocclusion was observed.
Our results showed that PCI represents a safe and efficient management strategy in CTO patients with low LVEF(<35%) able to ensure good immediate and long-term outcome.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)