Background: The benefits of revascularization in chronic totalocclusion (CTO) patients with reduced left ventricular ejection fraction (LVEF)still remain conflicting.The aim of this study is to investigate the clinicalimpact of CTO revascularization in patients with reduced LVEF compared withthose receiving medical treatment (MT).

Atotal of 369 consecutive patients who were diagnosed with CTO by coronary angiographywere allocated to either the group medical treatment (MT, n = 204) group orpercutaneous coronary intervention (PCI, n = 165) according to treatmentstrategies. The 5-year clinical outcomes were compared between the two groups. Primary endpoint was a cardiac death or a targetvessel revascularization (TVR) for CTO lesion.

After Inverse probability weighting (IPTW)analysis, the pseudo sample size in the MT group and PCI group was 364 and 370,respectively. After a median 6.0 yearsfollow-up period (interquartile range: 5.0 to 8.1 years), the incidence ofcardiac death (9.0% vs. 4.5%, P=0.019) and cardiac death under heart failurehospitalization (3.8% vs. 1.0%, P=0.017) were higher in MT group, but the incidenceof TVR for CTO lesion was higher in PCI group (11.5%vs. 22.7%, P<0.001). Based onlogistic regression analysis, patients with CTO revascularization had survivalbenefits for cardiac death (HR: 0.558 [95% CI: 0.327-0.953] ) and cardiac deathafter heart failure hospitalization (HR: 0.403 [95% CI: 0.164-0.990] ). 

Inour study, In patients with LV systole dysfunction (EF < 50%), successfulCTO revascularization is related to long-term survival benefits. These resultssuggest that a successful CTO revascularization is associated with a reductionin cardiac death after heart failure hospitalization.