Background
Methods
Patients and treatment
Cardiovascular magnetic resonance protocol
Segmental analysis
Statistical analysis
Results
Baseline clinical and procedural characteristics
Serial CMR (n = 180) | Total (n = 302) | ||||
---|---|---|---|---|---|
CTO-PCI (n = 80) | No CTO-PCI (n = 100) | CTO-PCI (n = 148) | No CTO-PCI (n = 154) |
P-value* | |
Age (years, mean, SD) | 60(10) | 60(10) | 60(10) | 60(10) | 0.81 |
Male gender (%) | 73(91) | 84(84) | 131(89) | 126(82) | 0.25 |
Diabetes (%) | 13(16) | 14(14) | 22(15) | 25(16) | 0.75 |
Hypertension (%) | 30(38) | 48(48) | 59(40) | 69(45) | 0.72 |
Family history of CAD (%) | 32(40) | 38(38) | 66(45) | 64(42) | 0.10 |
Hypercholesterolaemia (%) | 27(34) | 33(33) | 51(35) | 52(34) | 0.81 |
Current smoker (%) | 40(50) | 52(52) | 77(52) | 76(49) | 0.97 |
Previous MI (%) | 9(11) | 17(17) | 19(13) | 24(16) | 1.0 |
Previous PCI (%) | 5(6) | 13(13) | 9(6) | 16(10) | 0.21 |
Previous stroke (%) | 2(3) | 3(3) | 5(3) | 6(4) | 0.36 |
Primary PCI | |||||
Infarct related artery | 0.77 | ||||
Right coronary artery (%) | 26(32) | 31(31) | 46(31) | 47(31) | |
Left circumflex artery (%) | 15(19) | 30(30) | 30(20) | 43(28) | |
Left anterior descending artery/LM (%) | 39(49) | 39(39) | 72(49) | 64(42) | |
Three vessel disease (%) | 34(43) | 42(42) | 62(42) | 67(44) | 0.91 |
MI SYNTAX score I (pre-PCI) | 30(8) | 29(10) | 29(8) | 29(10) | 0.57 |
MI SYNTAX score II (wiring/balloon/aspiration) | 28(8) | 26(10) | 27(8) | 27(10) | 0.62 |
Infarct size | |||||
Peak CK-MB (median, IQR) | 133(38–198) | 87(39–199) | 130(39–272) | 111(43–256) | 0.14 |
Peak Troponin T(median, IQR) | 3.1(1.3–7.8) | 2.9(0.9–5.6) | 3.1(1.1–7.8) | 3.3(0.9–6.0) | 0.23 |
LVEF before randomization a
| 41(12) | 42(12) | 41(11) | 42(12) | 0.97 |
CTO characteristics | |||||
Patients with multiple CTOs b
| 11(14) | 13(13) | 13(9) | 22(14) | 0.28 |
CTO related artery | 0.61 | ||||
Right coronary artery | 32(40) | 54(54) | 46(43) | 78(51) | |
Left circumflex artery | 23(29) | 24(24) | 48(32) | 37(24) | |
Left anterior descending artery | 25(31) | 22(22) | 36(24) | 39(25) | |
CTO Collaterals Rentrop Grade 2–3 | 48(60) | 53(53) | 80(54) | 82(53) | 0.30 |
Total J-CTO score (mean, SD) | 2.0(1.1) | 2.2(1.1) | 2.1(1.1) | 2.3(1.1) | 0.07 |
Previously failed lesion | 1(1) | 4(4) | 2(1) | 4(3) | 0.41 |
Blunt stump | 17(21) | 27(27) | 33(22) | 45(29) | 0.51 |
Bending | 50(63) | 68(68) | 98(66) | 108(70) | 0.26 |
Calcification | 58(73) | 81(81) | 115(78) | 132(86) | 0.02 |
Occlusion length ≥ 20 mm | 30(38) | 43(43) | 60(40) | 68(44) | 0.48 |
Recovery of global left ventricular function
Total CMR population | CTO PCI (n = 80) | No-CTO PCI (n = 100) |
P-value |
---|---|---|---|
Left ventricular ejection fraction (%) | |||
Baseline | 40.6 (11.8) | 41.7 (12.1) | 0.55 |
4 months FU | 45.3 (11.6) | 45.5 (11.8) | 0.87 |
Δ LVEF | 4.6 (8.3) | 3.8 (8.1) | 0.52 |
Left ventricular end-diastolic volume (ml) | |||
Baseline | 210.1 (53.4) | 209.5 (55.1) | 0.95 |
4 months FU | 215.6 (54.6) | 212.5 (53.9) | 0.71 |
Δ LVEDV | 5.5 (32.4) | 3.0 (25.7) | 0.57 |
Infarct size (g) a
| |||
Baseline | 11.7 (10.5) | 11.9(11.1) | 0.94 |
4 months FU | 7.5 (6.4) | 7.1 (5.4) | 0.70 |
Δ Infarct size | −4.3 (8.0) | −4.8 (8.6) | 0.72 |
Recovery of overall segmental wall thickening
Segmental Wall thickening (%, SD) | Total | CTO territory | IRA territory | ||||||
---|---|---|---|---|---|---|---|---|---|
All segments | CTO PCI (s = 1184) | No-CTO PCI (s = 1392) |
P-value* | CTO-PCI (s = 392) | No-CTO PCI (n = 453) |
p-value* | CTO PCI (s = 397) | No-CTO PCI (s = 471) |
p-value* |
Baseline | 41 (34) | 43 (34) | – | 44 (35) | 40 (33) | – | 31 (28) | 33 (31) | – |
4 mo | 48 (32) | 46 (33) | – | 49 (33) | 43 (31) | – | 42 (32) | 42 (34) | – |
Absolute difference | 7 (30) | 4 (30) | – | 5 (31) | 3 (28) | 0.09 | 11 (28) | 8 (30) | – |
Dysfunctional segments (SWT Baseline < 45%) | CTO PCI (s = 722) | No-CTO PCI (s = 789) |
p-value* | CTO PCI (s = 226) | No-CTO PCI (s = 275) |
p-value* | CTO PCI (s = 297) | No-CTO PCI (s = 316) |
p-value* |
Baseline | 20 (15) | 19 (16) | – | 21 (16) | 19 (16) | – | 18 (15) | 16 (17) | – |
4 mo | 36 (28) | 31 (25) | 0.05 | 37 (30) | 30 (24) | 0.02 | 33 (27) | 30 (26) | – |
Absolute difference | 16 (26) | 13 (24) | 0.06 | 17 (27) | 11 (23) | 0.03 | 16 (24) | 14 (25) | – |
Dysfunctional and TEI <50% | CTO PCI (s = 574) | No-CTO PCI (s = 553) |
p-value* | CTO PCI (n = 186) | No-CTO PCI (n = 202) |
p-value* | CTO PCI (s = 222) | No-CTO PCI (s = 206) |
p-value* |
Baseline | 21 (15) | 20 (16) | – | 22 (16) | 20 (16) | – | 20 (14) | 18 (16) | – |
4 mo | 38 (28) | 33 (25) | 0.05 | 40 (30) | 31 (23) | 0.01 | 37 (27) | 33 (26) | – |
Absolute difference | 16 (26) | 13 (24) | 0.06 | 17 (27) | 11 (22) | 0.02 | 17 (25) | 15 (25) | – |
Dysfunctional and TEI >50% | CTO PCI (s = 36) | No-CTO PCI (s = 46) |
p-value* | CTO-PCI (s = 8) | No-CTO PCI (s = 7) |
p-value* | CTO PCI (s = 27) | No-CTO PCI (s = 37) |
p-value* |
Baseline | 8 (12) | 3 (15) | – | 3 (14) | 7 (13) | – | 9 (12) | 2 (16) | – |
4 mo | 18 (17) | 15 (21) | – | 20 (15) | 10 (15) | – | 18 (18) | 14 (21) | – |
Absolute difference | 11 (17) | 12 (24) | – | 16 (20) | 3 (18) | – | 9 (16) | 12 (24) | – |