Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

Background: The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on left ventricular ejection fraction (LVEF) remains controversial. Methods: We included patients who underwent CTO PCI (2018-2022) with reported baseline and follow-up LVEF (window 1-18 months). Stratified analyses according to procedural success, baseline LVEF, and target vessel were performed. Logistic regression analysis was performed to assess predictors of LVEF improvement. Results: We included 142 patients with available LVEF data, of whom 121 had successful CTO PCI (85.2%). Overall, mean age was 65.4 ± 10.3 years, 76.1% were men, and 81.0% were White. The attempted CTO vessel was left anterior descending in 31.7%, left circumflex in 17.6%, and right coronary artery in 50.0% of patients. The median time from PCI to follow-up echocardiogram was 8.4 months (IQR, 4.4-12.4). After successful CTO PCI, mean LVEF increased from a baseline of 48.2% ± 15.4% to 51.8% ± 14.2% (ΔLVEF 3.6%; P < .001). Among patients with depressed baseline LVEF <50%, there was greater improvement in LVEF from 32.6% ± 9.7% to 40.0% ± 12.9% (ΔLVEF 7.6%; P < .001), including 48.0% with ≥10% improvement. There was no change in LVEF after unsuccessful CTO PCI (54.6% ± 10.6% vs 55.2% ± 8.6%; P = .746). The ΔLVEF after successful CTO PCI to the left anterior descending, left circumflex, and right coronary artery was 2.6%, 4.0%, and 4.4%, respectively, overall, and 9.4%, 6.3%, 7.3% in patients with depressed baseline LVEF. Reduced baseline LVEF <50% was a strong independent predictor of LVEF improvement after successful CTO PCI (adjusted odds ratio, 5.60; 95% CI, 2.27-13.84; P < .001). Conclusions: Successful CTO PCI seems to be associated with modest LVEF improvement, which is more pronounced in patients with reduced baseline LVEF.