Benefits of CTO-PCI in Selected Cases With HFrEF (CTOHFrEF)

Observational studies have shown that chronic total coronary occlusion percutaneous intervention (CTO-PCI) improves angina, left ventricular ejection fraction (LVEF), and survival. None of these studies aimed to assess the benefits in populations with heart failure with reduced ejection fraction (HFrEF). The investigators studied the effect of CTO-PCI on left ventricular function and clinical parameters in patients with HFrEF.

Using cardiac magnetic resonance (CMR), the investigators studied 29 patients with HFrEF and evidence of viability and/or ischemia in the territory supplied by an occluded vessel who were successfully treated with CTO-PCI. Non-CTO PCI was also performed in patients with multi-vessel disease, . Imaging parameters, clinical status, and brain natriuretic peptide (BNP) levels were evaluated before and six months after CTO-PCI.

Inclusion criteria

• At least one chronic total coronary occlusion
• LVEF ≤40% by CMR
• Evidence of myocardial viability and/or ischemia in at least two contiguous segments subtended by the occluded vessel.

Exclusion criteria

• Women of childbearing age or pregnant
• Claustrophobia
• Admission to hospital within the previous 90 days due to decompensated heart failure, myocardial infarction or unstable angina.
• Severe valvulopathy
• Pacemaker or implantable cardioverter defibrillator
• Indication for coronary artery bypass surgery
• Heart transplantation waiting list
• Follow-up not feasible
• Life expectancy shorter than 12 months.
• Iodine contrast or gadolinium allergy
• Aspirin or clopidogrel allergy
• Asthma
• NYHA IV class
• Liver cirrosis
• Noncompliance with medical treatment
• Chronic kidney disease with serum creatinine levels ≥ 2.5 mg/dl or glomerular filtration rate ≤30 ml/min/1.73m2
• Evidence of active bleeding
• High risk of bleeding
• CTO distal vessel not visible through collateral circulation
• CTO distal vessel diameter <2mm
• Absence of acceptable vascular access