REVASC: Does CTO-PCI Improve Left Ventricular Function Compared to No-CTO-PCI?

Does percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs), also known as CTO-PCI, improve left ventricular function in addition to PCI of relevant coexisting non-CTO vessels (No-CTO-PCI)? This was the question that researchers from the University Heart Center Freiburg in Germany were looking to answer in the REVASC Trial, the findings of which were presented at TCT 2017.

The trial was based on 205 patients, 104 of whom were assigned to No-CTO-PCI and 101 of whom underwent CTO-PCI. The primary endpoint was segmental wall thickening measured by cMRI after six months. Secondary endpoints looked at left ventricular function after six months and major adverse cardiovascular events at 12 months.

Researchers found that CTO-PCI was "associated with a trend towards larger improvement in segmental wall thickening than No-CTO-PCI" in a subset of patients without major non-CTO lesions. The number of major adverse cardiovascular events at 12 months was also lower in the CTO-PCI group (6) compared to the No-CTO-PCI group (17). Clinically driven repeat revascularization occurred in 16 patients in the No-CTO-PCI group, compared to five in the CTO-PCI group. However, CTO-PCI did not appear to improve regional or global left ventricular function compared to No-CTO-PCI.

"Whether CTO-PCI may improve patient outcomes remains controversial," said ACC.org Editor-in-Chief Kim Eagle, MD, FACC. "These findings are a good first step in assessing the benefits, but should be considered preliminary given the small study size."

Clinical Topics: Anticoagulation Management, Stable Ischemic Heart Disease, Chronic Angina

Keywords: TCT17, Transcatheter Cardiovascular Therapeutics, Ventricular Function, Left, Coronary Vessels, Hirudins, Myocardial Ischemia, Angina, Stable


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