Impact of percutaneous coronary intervention for chronic total occlusion in patients with new onset heart failure

1. S.W. Rha¹, 
2. B.G. Choi¹, 
3. S.Y. Choi¹, 
4. C.U. Choi¹, 
5. E.J. Kim¹, 
6. C.G. Park¹, 
7. H.S. Seo¹,
8. D.J. Oh¹, 
9. S.H. Park² and 
10. J.Y. Park³

+Author Affiliations

1. Korea University Guro Hospital, Seoul, Korea, Republic of
2. Soonchunhyang University Cheonan Hospital, Cheonan, Korea, Republic of
3. Eulji University, Seoul Eulji Hospital, Seoul, Korea, Republic of

Abstract

Background: Heart failure is known to be associated with increased adverse clinical outcomes in coronary artery diseases. The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients (pts) with new onset heart failure is not clear. We compared the 12-month clinical outcomes of pts treated by PCI with optimal medical therapy (OMT) for CTO lesions in pts with new onset heart failure.

Methods: A total of 458 consecutive CTO pts newly diagnosed with heart failure or showing symptoms of heart failure (NYHA ≥class 2 or CCS ≥class 2) were divided into 2 groups; one group underwent PCI (PCI group; n=246) and the other group was treated with OMT (OMT group; n=212). Major clinical outcomes were compared between the two groups up to 12 months.

Results: At baseline, the OMT group had a higher prevalence of elderly, cerebrovascular accidents, de novo lesion, left main disease, multivessel disease, multivessel CTO, RCA-CTO, and abundant collaterals (≥grade 2), whereas the PCI group had a higher prevalence of male gender, prior MI, prior PTCA and LAD-CTO lesions. Clinical outcomes at 12 months were similar between the 2 groups except lower mortality in the PCI group (Table). After baseline adjustment by multivariate analysis, however, there was no difference between the 2 groups.

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Conclusions: In our study, mechanical revascularization by PCI for CTO lesions in pts with new onset heart failure as compared with OMT seems to have no benefit in reducing 12-month mortality. Long-term follow up with a larger study population will be necessary for further determination.