ArticleJournal of the American Heart Association2026
Association Between Optimal Revascularization for Chronic Total Occlusion and Long-Term Outcomes in Patients With Heart Failure With or Without Type 2 Diabetes.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe relationship between optimal revascularization for chronic total occlusion (CTO) lesions and long-term clinical outcomes in patients with heart failure with or without type 2 diabetes (T2D) remains unclear. Therefore, this study aimed to investigate the association between optimal or nonoptimal CTO percutaneous coronary intervention (CTO-PCI) and long-term adverse clinical outcomes in patients with heart failure with or without T2D.
methodsThis prospective cohort study included 1591 patients with heart failure who underwent CTO-PCI at Fuwai Hospital between January 2017 and December 2018. Patients were categorized based on CTO-PCI outcomes: failure, suboptimal revascularization, and optimal revascularization. The primary end point was a composite of cardiovascular death and target-vessel myocardial infarction (TVMI), whereas the secondary end point was a composite of all-cause death and myocardial infarction.
resultsDuring a median follow-up of 3.3 years, 89 (5.6%) cases of cardiovascular death/TVMI occurred. Patients who received optimal revascularization had significantly lower risks of both cardiovascular death/TVMI (hazard ratio [HR], 0.45 [95% CI, 0.27-0.76]) and all-cause death/myocardial infarction (HR, 0.53 [95% CI, 0.33-0.86]) compared with those with CTO-PCI failure. Subgroup analysis showed that these associations were significant in patients with T2D (cardiovascular death/TVMI: HR, 0.25 [95% CI, 0.13-0.49]; all-cause death/myocardial infarction: HR, 0.28 [95% CI, 0.15-0.53]), but not in those without T2D (cardiovascular death/TVMI: HR, 0.87 [95% CI, 0.32-2.40]; all-cause death/myocardial infarction: HR, 1.06 [95% CI, 0.40-2.85]).
conclusionsOur findings suggest that optimal revascularization during CTO-PCI is associated with a lower risk of adverse cardiovascular events in patients with heart failure, particularly in those with T2D.
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