Effect of late percutaneous angioplastic recanalization of total coronary artery occlusion on left ventricular remodeling, ejection fraction, and regional wall motion

The clinical benefit of late recanalization of complete coronary occlusion is debated. Left ventricular (LV) function and volumes are major prognostic determinants in patients with coronary artery disease. We sought to assess comprehensively the evolution of global and regional LV function and LV volumes after percutaneous recanalization of chronic complete coronary artery occlusions. A consecutive series of 55 patients who underwent successful percutaneous recanalization of a chronic (≥10 days), total (Thromborysis in Myocardial Infarction trial flow grade 0) occlusion of the left anterior descending or dominant right coronary arteries, and in whom a complete angiographic evaluation was available before angioplasty and at follow-up was studied. At follow-up, 38 patients had a patent artery (group 1) and 17 had a reocclusion (group 2). Baseline parameters were similar in the 2 groups. In group 1, LV ejection fraction increased from 55 ± 14% to 62 ± 13% (p < 0.001), with an increase in fractional shortening in the occluded artery territory (0.43 ± 0.30 to 0.71 ± 0.34, p < 0.001), while LV end-diastolic volume remained unchanged. In group 2, ejection fraction and regional wall motion were unchanged, while LV end-diastolic volume index increased (86 ± 22 ml/m2 to 99 ± 34 ml/m2, p < 0.02). The evolution in LV global and regional function was similar in patients with or without previous myocardial infarction; however, prevention of LV remodeling was observed only in patients with previous infarction. Maintained patency after successful recanalization of totally occluded coronary arteries improves global and regional LV function and, in patients with previous myocardial infraction, avoids LV remodeling.