Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy.

To evaluate the impact of left circumflex artery (LCX) or right coronary artery (RCA) chronic total occlusion percutaneous coronary intervention (CTO PCI) on left ventricular ejection fraction (LVEF) in heart failure patients with reduced ejection fraction (HFrEF). The effect of RCA or LCX CTO PCI on HFrEF patients remains understudied. We conducted a retrospective analysis of patients with HFrEF (EF <40%) who underwent LCX or dominant RCA CTO PCI at a high-volume center. The primary outcome was LVEF change, while secondary outcomes included in-hospital and long-term major adverse cardiovascular events (MACE). Subgroup analyses assessed the influence of myocardial viability testing and optimal heart failure therapy (OHFT) on LVEF change. From December 2014 to February 2022, 111 HFrEF patients underwent non-LAD CTO PCI, with a 93.6% technical success rate and 5.4% in-hospital MACE rate. At a median 27.4-month follow-up, LVEF significantly improved by 8.2% (95% CI 5.9% to 10.7%, p <0.001). RCA CTO PCI led to a 9.6% LVEF increase (95% CI 6.7% to 12.6%, p <0.001), while LCX PCI resulted in a 5.6% improvement (95% CI 1.3% to 9.8%, p = 0.011). Preprocedure viability testing (p = 0.310) and postprocedural OHFT (defined as three classes of guideline-directed medical therapy, p = 0.673) were not significantly associated with LVEF changes. Non-LAD CTO PCI significantly improved LVEF (8.2%) in HFrEF patients over 2 years, regardless of preprocedure viability testing or postprocedural medical therapy.