Impact of percutaneous coronary intervention of chronic total occlusions on absolute perfusion in remote myocardium

Ruben W. de Winter, Stefan P. Schumacher, Pepijn A. van Diemen, Ruurt A. Jukema, Yvemarie B. O. Somsen, Wynand J. Stuijfzand, Roel S. Driessen, Michiel J. Bom, Henk Everaars, Albert C. van Rossum, Peter M. van de Ven, Maksymilian P. Opolski, Niels J. Verouden, Ibrahim Danad, Pieter G. Raijmakers, Alex Nap, Paul Knaapen

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

BACKGROUND: Revascularisation of a chronic total coronary occlusion (CTO) impacts the coronary physiology of the remote myocardial territory. AIMS: This study aimed to evaluate the intrinsic effect of CTO percutaneous coronary intervention (PCI) on changes in absolute perfusion in remote myocardium. METHODS: A total of 164 patients who underwent serial [15O]H2O positron emission tomography (PET) perfusion imaging at baseline and three months after successful single-vessel CTO PCI were included to evaluate changes in hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in the remote myocardium supplied by both non-target coronary arteries. RESULTS: Perfusion indices in CTO and remote myocardium showed a positive correlation before (resting MBF: r=0.84, hMBF: r=0.75, and CFR: r=0.77, p<0.01 for all) and after (resting MBF: r=0.87, hMBF: r=0.87, and CFR: r=0.81, p<0.01 for all) CTO PCI. Absolute increases in hMBF and CFR were observed in remote myocardium following CTO revascularisation (from 2.29±0.67 to 2.48±0.75 mL·min-1·g-1 and from 2.48±0.76 to 2.74±0.85, respectively, p<0.01 for both). Improvements in remote myocardial perfusion were largest in patients with a higher increase in hMBF (β 0.58, 95% CI: 0.48-0.67, p<0.01) and CFR (β 0.54, 95% CI: 0.44-0.64, p<0.01) in the CTO territory, independent of clinical, angiographic and procedural characteristics. CONCLUSIONS: CTO revascularisation resulted in an increase in remote myocardial perfusion. Furthermore, the quantitative improvement in hMBF and CFR in the CTO territory was independently associated with the absolute perfusion increase in remote myocardial regions. As such, CTO PCI may have a favourable physiologic impact beyond the intended treated myocardium.

Original languageEnglish
Pages (from-to)e314-e323
JournalEuroIntervention
Volume18
Issue number4
Early online date6 Dec 2021
DOIs
Publication statusPublished - 22 Jul 2022

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