REVASC: CTO PCI Does Not Improve LV Function but Seems to Provide Symptom Relief

REVASC: CTO PCI Does Not Improve LV Function but Seems to Provide Symptom Relief 649 374 C-Suite Network
REVASC: CTO PCI Does Not Improve LV Function but Seems to Provide Symptom Relief

DENVER, CO—For patients receiving optimal medical therapy, stenting a chronic total occlusion (CTO) does not provide a boost in either regional or global LV function, the REVASC trial shows.

The change in segmental wall thickening measured by cardiac MRI (primary endpoint) was not improved in patients who underwent CTO PCI versus those who received optimal medical therapy with or without intervention on non-CTO lesions, Kambis Mashayekhi, MD (University Heart Center Bad Krozingen, Germany), presented at TCT 2017 here.

A secondary MACE endpoint, however, showed an advantage for CTO PCI at 1 year, driven primarily by a reduction in the rate of clinically driven repeat revascularization (5.0% vs 15.4%). Typically, patients were coming back due to severe angina symptoms, Mashayekhi said at a press conference.

Emmanouil Brilakis, MD (Minneapolis Heart Institute, MN), who was not involved in the study, told TCTMD, “That reinforces the point that the number one reason we’re doing CTO PCI remains symptom improvement rather than ejection fraction improvement.”

The trial was not powered for clinical outcomes, he noted, but the finding “is consistent with everything that we know so far.”

A large, sham-controlled trial is needed to definitively assess whether CTO PCI is improving symptoms, Brilakis said, noting that his group started the SHINE-CTO trial, which will randomize an estimated 142 patients to CTO PCI or a sham procedure, about a year ago. The primary endpoint is the change in disease-specific health status as assessed by the Seattle Angina Questionnaire.

Controversy Remains

Mashayekhi said that CTOs can be found in about 18% of patients undergoing diagnostic coronary angiography and pointed out that debate continues regarding whether PCI of those lesions is beneficial.

One trial—EUROCTO—showed that CTO PCI boosts health status, with improvements in angina frequency, physical limitations, and quality of life, in patients with stable angina….