Efficacy of revascularization in CTO patients based on hibernating myocardium therapy

Wenjie Chen; Zhiyong Du; Yanwen Qin; Ze Zheng; Jinghua Liu; Yuchen Shi

doi:10.1111/eci.14237

Efficacy of revascularization in CTO patients based on hibernating myocardium therapy

Eur J Clin Invest. 2024 May 17:e14237. doi: 10.1111/eci.14237. Online ahead of print.

Authors

Wenjie Chen¹, Zhiyong Du², Yanwen Qin², Ze Zheng¹, Jinghua Liu¹, Yuchen Shi¹

Affiliations

¹ Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

PMID: 38757632
DOI: 10.1111/eci.14237

Abstract

Background: The effectiveness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still uncertain, especially for patients with ischemic left ventricular dysfunction. This study aimed to assess hibernating myocardium (HM), as determined by single-photon emission computed tomography (SPECT) and ¹⁸F-FDG positron emission tomography (PET), and to compare the benefits of PCI and optimal medical therapy (OMT).

Methods: A retrospective study collected data from 332 patients with CTO and ischemic left ventricular dysfunction. The study compared patients who underwent PCI or OMT via propensity score matching (PSM) analysis which was performed with a 1:2 matching protocol using the nearest neighbour matching algorithm. The primary endpoint of the study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for worsening heart failure (WHF), revascularization and myocardial infarction (MI).

Results: After PSM, there were a total of 246 individuals in the PCI and OMT groups. Following Cox regression, hibernating myocardium/total perfusion defect (HM/TPD) was identified as an independent risk factor (hazard ratio (HR): 1.03, 95% confidence interval (CI): 1.008-1.052, p = .007). The cut-off value of HM/TPD was 38%. The results of the subgroup analysis suggest that for patients with HM/TPD >38%, the OMT group had a greater risk of MACE (p = .035). A sensitivity analysis restricting patients with single-vessel CTO lesions, HM/TPD remained an independent predictor (HR 1.025, 95% CI 1.008-1.043, p = .005).

Conclusion: HM/TPD is an independent predictor of MACE, and for patients with HM/TPD > 38%, CTO-PCI had a lower risk of MACE compared with OMT. However, further validation is still needed through large-scale studies.

Keywords: chronic total occlusion (CTO); hibernating myocardium; optimal medical therapy (OMT); percutaneous coronary intervention (PCI).

Abstract

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