In-Hospital and Follow-Up Outcomes after Chronic Total Occlusion Percutaneous Coronary Intervention According to Left Ventricular Ejection Fraction: Insights from the PROGRESS-CTO Registry

Background: Outcomes of chronic total occlusion percutaneous coronary intervention (CTO PCI) according to baseline left ventricular ejection fraction (LVEF) have received limited study.

Methods: We compared clinical, angiographic, procedural characteristics and outcomes of 1,441 CTO PCIs performed in patients with known ejection fraction and available follow-up. We compared patients with LVEF ≥50% (N=834), LVEF 35%-49% (N=434) and LVEF <35% (N=173).

Results: Left anterior descending CTO was significantly more common in the low LVEF group (24% vs 25% vs 42%, p<0.001). The J-CTO score was similar (2.4 ± 1.3 vs 2.5 ± 1.2 vs 2.4 ± 1.2, p=0.5), as was procedural success (85% vs 83% vs 88%, p=0.5), with and the incidence of in-hospital major adverse cardiovascular events being numerically but not statistically higher in the LVEF<35% group (2% vs 3.5% vs. 4.6%, p=0.12). The composite endpoint of death, myocardial infarction (MI) and revascularization at 1 year was more common in the LVEF<35% group (13% vs 17% vs 25 %, plog-rank=0.001) (Figure). There was a significant difference in 1-year mortality (12.8% vs 16.8% vs 24.6%, p<0.001), but not in MI (1.9% vs 4.4% vs 5.6%, p=0.07) and revascularization rates (7.4% vs 8.9% vs 10.7%, p=0.8).

Conclusion: CTO PCI can be performed with high success rates and acceptable in-hospital complication rates irrespectively of LVEF, but patients with LVEF<35% have worse one-year outcomes.