Impact of successful and failed revascularization of chronic total occlusion on left ventricular function and infarct size
Journal of Cardiovascular Magnetic Resonance ,
Jan 2010
Gideon A Paul , Mo Zia , Kim A Connelly , Paul Fefer , Brad H Strauss , Alexander J Dick , Graham A Wright
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Impact of successful and failed revascularization of chronic total occlusion on left ventricular function and infarct size
Gideon A Paul
1
Mo Zia
1
Kim A Connelly
0
Paul Fefer
1
Brad H Strauss
1
Alexander J Dick
1
Graham A Wright
1
0
St Michael's Hospital
,
Toronto, ON
,
Canada
1
Sunnybrook Health Sciences Centre
,
Toronto, ON
,
Canada
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010
-
Introduction
Non-randomised studies have reported a prognostic
advantage with percutaneous coronary intervention (PCI)
in the treatment of chronic total occlusions (CTO). Failure
to cross and successfully open a CTO confers a worse
clinical outcome, however most trials have included
occlusions of short duration (7-30 days). PCI success rates are
inversely related to the age of vessel occlusion reflecting
temporal, cellular changes within a CTO, namely
progressive collagen deposition.
Purpose
To assess the medium-term cardiac outcomes of PCI in the
treatment of true CTO (endorsed by an expert consensus
panel, requiring Thrombolysis In Myocardial Infarction
[TIMI] flow grade 0 on angiography and 12 weeks
duration) using quantitative cardiac magnetic resonance
(CMR) imaging.
Methods
23 patents (mean age 60 11, 82% male) referred for PCI
to a single vessel de novo CTO underwent CMR
examination within one week prior to and 6 months after their
procedure. PCI success was defined as recanalisation of
the occluded vessel and stent implantation with a final
residual diameter stenosis <30%. Left ventricular (LV)
function and transmural extent of infarction (TEI) were
assessed using standard SSFP and T1-weighted imaging on
a 1.5 T MRI system. LV volumes and mass were quantified
using a dedicated software package (QMass). Segmental
wall thickening (SWT) was calculated by (end systolic
end-diastolic wall thickness)/end-diastolic wall thickness
100%. Myocardial segments were considered
dysfunctional if SWT was 45%. Viable segments included
dysfunctional myocardium with TEI <25%.
Results
TIMI 3 flow was successfully achieved in 13 of the 23
patients (59%), all treated with drug eluting stents.
Baseline demographics were well matched in each group
(Table 1). Opening a CTO did not result in improvement
in either regional or global systolic function however it
was associated with a significant increase in SWT in
dysfunctional but viable segments (Table 2). Failed PCI was
not associated with a worse cardiac outcome in terms of
LV remodelling and infarct size as compared to patients
with an open artery however one patient experienced a
peri-procedural myocardial infarct (MI).
Conclusion
In this single-centre pilot study failed revascularisation of
true CTOs was not associated with worse cardiac
outcomes compared to successful PCI. Despite a lack of
improvement in global systolic function opening a CTO
improved SWT within dysfunctional but viable segments.
Larger, randomised studies are required to assess the
longterm benefits and morbidity of PCI in the treatment of
CTOs.
56 8.9 57 7.6 0.64 57.5 8.8 57.0 6.9 0.76 0.22
62.8 12.2 63.8 14.4 0.61 59.9 9.9 61.4 10.7 0.59 0.89
28.4 8.8 27.6 8.8 0.52 25.6 6.86 26.3 6.4 0,68 0.46
7.0 5.3 8.7 6.1 0.17 8.0 6.2 10.9 6.8 0.17 0.14
9.0 5.9 12.0 7.6 0.19 10.0 7.7 13.3 8.2 0.14 0.86
62.6 16.6 62.0 17.9 0.93 56.7 16.8 50.4 19.5 0.32 0.54
31 10.1 50.8 23.1 0.02 26.3 9.5 25.8 10.9 0.71 0.047
0 0
(...truncated)
This is a preview of a remote PDF: http://www.jcmr-online.com/content/pdf/1532-429X-12-S1-P210.pdf
Gideon A Paul, Mo Zia, Kim A Connelly, Paul Fefer, Brad H Strauss, Alexander J Dick, Graham A Wright.
Impact of successful and failed revascularization of chronic total occlusion on left ventricular function and infarct size ,
Journal of Cardiovascular Magnetic Resonance,
2010, pp. P210, 12,