Real-world outcomes and predictors of LV reverse remodelling after successful CTO PCI in HFrEF: insights from a multicentre registry
J Park, D K Kim, S H Kim, K H Kim, D I Kim, Y S Song, J N Yoo, Y S ChoAbstract
Background
Chronic total occlusion (CTO) is common in ischaemic heart failure with reduced ejection fraction (HFrEF) and is associated with adverse prognosis. The clinical significance of left ventricular (LV) reverse remodelling after successful CTO percutaneous coronary intervention (PCI) remains uncertain.
Purpose
To evaluate the association between LV reverse remodelling after successful CTO PCI and clinical outcomes in HFrEF, and to identify predictors of LV reverse remodelling.
Methods
Using a multicentre retrospective CTO registry (34 centres), we included patients with baseline LVEF ≤35% who underwent successful CTO PCI. LV reverse remodelling was defined as an absolute increase in LVEF ≥10 percentage points from baseline to follow-up echocardiography. The primary outcome was all-cause mortality; secondary outcomes were CV mortality and MACE (CV death, non-fatal stroke, non-fatal MI) through 3 years. Associations between reverse remodelling and outcomes were assessed using Cox proportional hazards models adjusted for age, sex, diabetes, baseline LVEF, and extent of CAD. Predictors of reverse remodelling were evaluated using multivariable logistic regression.
Results
In the overall CTO registry (n=9,316), 1,032 patients (11.1%) had baseline LVEF ≤35%. Among these, 402 patients underwent successful CTO PCI and had available post-PCI follow-up echocardiography. Among the 402 patients (mean age 65.0±12.8 years; 79.9% male), 148 (36.8%) experienced LV reverse remodelling. Baseline LVEF was 26.6±6.2% in the reverse-remodelling group versus 28.2±5.6% in the non-remodelling group, while follow-up LVEF was 46.9±9.3% versus 30.7±7.2%, respectively. Beta-blocker and RAS inhibitor use at discharge was comparable between groups. Compared with patients without reverse remodelling, those with reverse remodelling had lower risks of all-cause mortality (adjusted HR 0.46, 95% CI 0.25–0.86; p=0.015), MACE (adjusted HR 0.40, 95% CI 0.16–0.99; p=0.050), and CV mortality (adjusted HR 0.27, 95% CI 0.08–0.93; p=0.038). Independent predictors of reverse remodelling were absence of diabetes (diabetes: adjusted OR 0.580, 95% CI 0.375–0.897; p=0.014) and lower baseline LVEF (per 1% increase: adjusted OR 0.954, 95% CI 0.919–0.991; p=0.014).
Conclusion
In patients with HFrEF (LVEF ≤35%) undergoing successful CTO PCI, LV reverse remodelling occurred in more than one-third and was associated with significantly lower risks of all-cause mortality, MACE, and CV mortality over follow-up. Baseline LVEF and diabetes status may help identify patients more likely to experience reverse remodelling after CTO PCI.3-year clinical outcomesFor image description, please refer to the figure legend and surrounding text.Predictors of LV reverse remodelingFor image description, please refer to the figure legend and surrounding text.