| Objective-The primary purpose of this retrospective study was to evaluate the effect of percutaneous coronary intervention (PCI) on Left ventricular function and ventricular remodeling in patients with chronic total occlusion of coronary artery. The other purposes were to compare clinical character of coronary artery lesion and major adverse cardiac events between the same two groups.Methods-Fifty four patients (37CTO PCI success and17CTO PCI failure), who had no significant difference in their basic and clinical characteristics, and had undergone CTO PCI of at least one lesion, were selected for the study. To be included, a patient must have had either a de novo total occlusion in a native coronary artery (diameter of the at least2.5mm) with no luminal continuity in coronary artery angiography, i.e. TIMI flow grade0or a partial occlusion i.e. TIMI flow grade I, also described as functional occlusions, where a faint, late anterograde flow with incomplete opacification of the distal vessel could be seen in the absence of a discernible channel lumen. None of them had emergency PCI or a myocardial infarction within90days of the procedure. Patients with elevated cardiac biomarkers on admission for PCI were also excluded. The other reasons for exclusion were-severe valvular heart disease, dilated cardiomyopathy, hypertrophic cardiomyopathy, cardiogenic shock, chronic renal or hepatic failure and patients with history of coronary artery bypass grafting (CABG). Each of them had standard2D ECHOCARDIOGRAPHY (biplane Simpson method) done just before and at least ten months (mean15.72±5months) after the procedure. The data from ECHO record were utilized to evaluate Left ventricular ejection fraction (LVEF), Left ventricular end diastolic volume (LVEDV) and Left ventricular end systolic volume (LVESV).The corresponding echocardiographic parameters in each patient were compared within the group to assess the effect of revascularization. The patients were then followed prospectively for any major adverse cardiac events (MACE). It included Death, Myocardial Infarction (MI), unstable angina (UA); Coronary artery bypass surgery (CABG).This follow up period was10months. The follow up data were collected from the subsequent hospital admission records (if any) and the telephone call to the patients. The data were analyzed using SPSS17statistics software. P<0.05was considered to have statistical significance.Results-Most patients in the success group were male (89.1%) with a mean age of59.14±11.56years. Among the group,45.9%were diabetes mellitus;70.2%were hypertensive; and56.7%were smokers. The left ventricular ejection fraction (LVEF) significantly increased (59.70±12.11vs.63.75±9.01, p<0.05) along with improvement in regional wall motion in those who had successfully undergone PCI. LVEF improvement was even more prominent (46.05±8.28vs.53.70±11.38, p=0.007) in those whose myocardium was severely injured, i.e. prePCI LVEF<60%.On subgroup analysis, there was improvement in LVEF (57.54±15.42vs.60.09±12.08, p=0.14) in patients who were previously successfully revascularized and had undergone repeat PCI for restenosis during follow up. Increase in LVEF were statistically significant in those who had CTO lesion opened in Left anterior descending (LAD) and Right coronary (RCA) arteries (58.9±13.92vs.62.85±10.72, p=0.024and58.61±9.92vs.65.07±7.64, p=0.019respectively) also. The left ventricular end diastolic volume index (LVEDVI), and left ventricular end systolic volume index (LVESVI) were significantly reduced (LVEDVI69.57±24.66vs.63.20±20.28, p<0.05and LVESVI29.14±17.21vs.24.37±13.28, p<0.05respectively) in those who succeed the procedure. There was marked improvement in symptoms and less occurrence of major adverse cardiac events in the success group.Conclusion-The left ventricular function improves after PCI in patients with CTO. Improvement is more prominent in severely injured viable myocardium. The beneficial effect of the revascularization CTO in ventricular remodeling can be observed even after one year. |
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