Long-term Effect Of Successful Interventional Therapy In Patients With CTO Complicated With Left Ventricular Systolic Dysfunction

Purpose: To explore the therapeutic value of interventional therapy(PCI)for patients with chronic complete coronary occlusion(CTO)combined with left ventricular systolic dysfunction(HFr EF)through retrospective analysis.Methods: We selected patients from the Department of Cardiology,Xiangtan Central Hospital from January 1,2012 to December 31,2019,who were hospitalized for CTO diagnosed by coronary angiography and diagnosed by cardiac ultrasound for HFr EF,and 196 patients met the inclusion and exclusion criteria.According to the successful interventional treatment of CTO lesions(the success rate of CTO PCI operation was86.44%),the patients were divided into study group(n = 102 cases)and control group(n = 94 cases).According to whether the patients were treated with complete revascularization or not,the patients in the study group were further divided into complete revascularization group(n = 21cases)and partial revascularization group(n = 81 cases).The control group only received the best drug treatment.LVEF,CCS angina pectoris classification and NYHA cardiac function classification were the main end points of the study.The survival time,the incidence of MACE and the rate of rehospitalization due to cardiac reasons were taken as the secondary end points of the study.The follow-up methods included in-hospital follow-up,outpatient follow-up and telephone follow-up.Results: 18 patients lost follow-up,and the rest were followed up from January 2012 to December 2020,with an average follow-up time of41.01 ±22.89 months.1.Comparison of general data: the scores of age,Japanese multicenter CTO registration study(J-CTO、J-Channel CTO)in the control group were higher than those in the complete revascularization group and partial revascularization group.The history of PCI and myocardial infarction in the complete revascularization group and partial revascularization group were higher than those in the control group,but there was no significant difference in other general data.3.Secondary clinical endpoints: The total revascularization group was superior to the control group in the incidence of MACE events,the rate of readmission for cardiac reasons and the survival time of all-cause death events(P<0.05).The incidence of MACE events in partial revascularization group was higher than that in complete revascularization group(P<0 05),but there was no significant difference in survival time of all death events and readmission rate due to cardiac reasons(P>0.05).The incidence of MACE events and the rate of rehospitalization due to cardiac reasons in the control group were higher than those in the partial revascularization group(P<0.05),but there was no significant difference in the survival time of all-cause death(P>0.05).4.Medicine use: when selected,the rate of taking isosorbide mononitrate,nicorandil and trimetazidine in the control group was higher than that in the complete revascularization group and partial revascularization group(P<0.05),but there was no statistical difference in other drugs among the three groups(P>0.05).At the end of follow-up,the rate of taking β-blockers,spironolactone,Angiotensin Converting Enzyme Inhibitors(ACEI)/ Angiotensin Receptor Blockers(ARB)/ Angiotensin Receptor Neprilysin Inhibitor(ARNI),and diuretics in the complete revascularization group was lower than that in the partial revascularization group and the control group(P<0.05).Conclusion: 1.For CTO patients with left ventricular systolic dysfunction(LVEF ≤ 40%),if the intervention of CTO lesions is not difficult,the longterm effect of interventional therapy combined with standard optimal medical therapy is significantly better than that of standard optimal medical therapy alone.2.For patients with CTO disease who are difficult to intervene,especially those who have high difficulty in retrograde approach,hemodynamic support should be used to reduce the risk of operation if they have to be treated with interventional therapy.Interventional therapy can also benefit significantly while reducing the risk.3.Simple standardized drug therapy can also partially benefit.