Assessment of percutaneous coronary intervention on regional and global left ventricular function in patients with chronic total occlusions

Background: The improvement of regional and global ventricular function following percutaneous coronary intervention (PCI) with reperfusion of the artery supplying the infarct area in acute myocardial infarction is well-described. However, little is known of the potential effects of late recanalization of chronic coronary artery occlusion on left ventricular function. Objective: To determine whether PCI improves regional and global left ventricular function in patients with chronic coronary artery occlusions. [Patients and methods: Thirty-five patients having at least one coronary artery occluded for six weeks or longer were included in the present prospective study. Exercise thallium-201 myocardial perfusion scintigraphy, multiple-gated acquisition ventriculography and two-dimensional echocardiography were performed in 19 patients (16 men; mean age of 58±5 years) who underwent a successful PCI to assess both regional and global left ventricular function before and six weeks following the procedure. Results: The mean ejection fractions before and after reperfusion were 51±7% and 58±6% using Simpson's method (P<0.001) by echocardiography, and 45±1% and 53±1% (P=0.01) by multiple-gated acquisition ventriculography, respectively. The echocardiographic wall motion score was 24±9 before and 15±6 after PCI (P<0.001). The exercise perfusion score (21±1 and 14±1 [P=0.01]), rest perfusion score (15±1 and 12±1 [P=0.02]) and reinjection perfusion score (14±1 and 11.1±1 [P=0.07]) also improved after PCI. The presence of angina was strongly associated with an improvement in left ventricular function and wall motion score (P<0.01). Conclusions: PCI significantly improved the regional and global left ventricular function in patients with chronic total coronary occlusion. This procedure may provide symptom benefits in selected patients.