Clinical Improvement Without Ventricular Function Improvement After CTO

The benefits offered to patients by attempting the rechanneling of a chronic total occlusion are still unclear. Additionally, sometimes the procedural risks are somewhat undetermined.

Taking into account these controversies, this work sought to prove whether successful rechanneling of a chronic total occlusion improves ventricular function. This is not a soft endpoint; it has been associated with mortality in multiple studies and settings.

All patients with chronic total occlusion (CTO) eligible for angioplasty were included and randomized to rechanneling or medical treatment. All additional significant lesions were treated before randomization.

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All patients underwent cardiac magnetic resonance imaging at baseline and 6 months after the procedure.

The primary endpoint was the change in segmental ventricular wall thickening in the CTO area. Secondary endpoints included improvement of regional motility and changes in ejection fraction. All major cardiovascular events at 12 months were also registered.

In total, 101 patients underwent rechanneling of their chronic total occlusion and 104 received medical treatment.

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Thickening of the left ventricular wall was similar for those who underwent angioplasty and those who did not (4.1 [14.6 to 19.3] vs. 6.0 [8.6 < 6.0]; p = 0.57). Similar results were obtained as regards other regional or global function indexes.

The subgroup analysis showed that only patients without other lesions besides the total occlusion (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX] score ≤13) improved in segmental wall thickening after angioplasty (p for interaction = 0.002).

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Major cardiovascular event rates at 12 months turned out to be lower in the angioplasty group (16.3% vs. 5.9%, p = 0.02).

Conclusion

No benefits were observed as regards the primary endpoint (wall thickening in the revascularized segment) or any other segmental or global ventricular function index. There was, however, a reduction in major cardiovascular events at 12 months in patients who underwent angioplasty for total occlusion.

Original title: A Randomized Trial to Assess Regional Left Ventricular Function After Stent Implantation in Chronic Total Occlusion. The REVASC Trial.

Reference: Kambis Mashayekhi et al. J Am Coll Cardiol Intv 2018. Online before print.

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