Long-term clinical outcomes of revascularization compared with medical treatment in chronic total occlusion patients with reduced left ventricular ejection fractions

BACKGROUND: The benefits of revascularization in patients with chronic total occlusion (CTO) and reduced left ventricular ejection fraction (LVEF) remain controversial. PURPOSE: This study aimed to investigate the clinical impact of CTO revascularization in patients with reduced LVEF compared with those receiving medical treatment (MT). METHODS: In total, 369 consecutive patients diagnosed with CTO by coronary angiography were allocated to either the MT group ( n = 204) or the percutaneous coronary intervention (PCI, n = 165) group according to the treatment strategy. The 5-year clinical outcomes were compared between the two groups using a Cox proportional hazards model. RESULTS: After inverse probability treatment weighting analysis, the pseudo-sample sizes in the MT and PCI groups were 364 and 370, respectively. After a median 6-year follow-up period (interquartile range, 5.0-8.1 years), the incidence of cardiac death was higher in the MT and PCI groups, at 9.0 and 4.5%, respectively ( P = 0.019). Cardiac death following heart failure hospitalization occurred in 3.8 and 1.0%, respectively ( P = 0.017). In contrast, target vessel revascularization for CTO lesions was more frequent in the PCI group than in the MT group (11.5 and 22.7%, respectively, P < 0.001). In the inverse probability treatment weighting population, patients undergoing CTO revascularization had survival benefits for cardiac death [hazard ratio: 0.48 (95% CI, 0.26-0.88)] and cardiac death after heart failure hospitalization [hazard ratio: 0.27 (95% CI, 0.08-0.84)]. CONCLUSION: In patients with LV systolic dysfunction, particularly those with EF less than or equal to 40%, successful CTO revascularization is associated with long-term survival benefits. These results suggest that successful CTO revascularization is associated with reduced rates of cardiac death and death after hospitalization for heart failure.