2023 CVIT (Japanese Association of Cardiovascular Intervention and Therapeutics)

1. Benefits of RCA CTO-PCI Based on Clinical Data
in Our Hospital
Dept. of Cardiology, Tokyo General Hospital, Japan
Yukihiro Yamaguchi, Toshiya Muramatsu
Rintaro Taniguchi, Ippei Tsuzuki, Emi Tajima
Kenji Makino, Mami Kawano, Hideyuki Takimura
Nakano Masatsugu, Reiko Tsukahara
Cardiovascular Intervention and Therapeutics (CVIT) 2023
Dept. of Cardiology, Tokyo General Hospital, Japan

2. the Japanese Association of
Cardiovascular Intervention and Therapeutics
COI Disclosure
Yukihiro Yamaguchi
The authors have no financial conflicts of interest
to disclose concerning the presentation.

3. Background
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT)
There are some data of improved LVEF/LVEDV after CTO-PCI, but there is no clear evidence for RCA CTO.
Alfredo R. et al. J Am Coll Cardiol Intv. 2017 Nov, 10 (21) 2158–
2170
Henriques, J.P.S. et al. J Am Coll Cardiol. 2016 Oct, 68 (15) 1622–1632
In CTO patients with low LVEF, PCI could represent a safe and effective
revascularization strategy achieving good midterm outcome and LVEF
improvement.
LVEF improved significantly at 6 month
a subgroup analysis suggests that patients with CTO in the LAD
may benefit from early additional CTO PCI.
LVEDV(ml)
LVEF(%)

4. Purpose
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT)
・We would like to show our data on LVEF/LVEDV of patients
after RCA CTO-PCI in our hospital and propose the
effectiveness.

5. Subject
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
CTO-PCI OMT
CTO-PCI OMT
36 patients with RCA CTO
who diagnosed by coronary angiography (CAG)
from January 2017 to March 2020
The observation time was 24 months
PCI group
14 cases
Optimal Medical Therapy group
12 cases
Study design > a non-randomized retrospective analysis
Cardiovascular Intervention and Therapeutics (CVIT)
*The treatment plan was at the discretion of the attending physician.
*No lesions in LCA.
excluding 3 cases PCI-failure,
6 cases follow-up loss
excluding 1 follow-up loss

6. Evaluated items
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT)
Primary endpoint >
・ MACE (all cause death, MI, TLR), major bleeding,
hospitalization for heart failure.
Secondary endpoint >
・ Differences in left ventricular ejection fraction (LVEF) and
left ventricular end diastolic volume (LVEDV) after PCI.

7. Patient characteristics
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT)
PCI group (n=14) OMT group (n=12) p value
Age(years) 73.1±10.3 75.9±8.6 n.s.
Female (%) 4(28.6) 1(8.3) n.s.
BMI (kg/m2) 22.8±2.9 25.3±2.5 n.s.
Hypertension (%) 9(64.3) 11(58.1) n.s.
Hypercholesterolemia (%) 9(64.3) 9(75.0) n.s.
Diabetes (%) 5(35.7) 2(16.7) n.s.
Hemodialysis (%) 0(0) 1(8.3) n.s.
eGFR (mL/min/1.73m2) 63.2+14 50.8±16.8 <.005
PAD(%) 1(7.1) 3(25.0) n.s.
PMI/CRT-D (%) 1(7.1)/0 1(8.3)/0 n.s.
Pre LVEF (%) 52.1±15.6 54.1±15.1 n.s.
Pre LVEDV(ml) 115.0± 44.5 122.3±40.8 n.s.
There were no significant differences except for
eGFR.

8. Patient characteristics ②
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT)
PCI group (n=14) OMT group (n=12) p value
Lesion - no. (%)
Seg.1 8(57.1) 6(50.0) n.s.
Seg.2 1(7.1) 1(8.3) n.s.
Seg.3 5(35.7) 5(41.2) n.s.
In-stent-occlusion - no. (%) 3(21.4) 2(16.7) n.s.
Medication therapy - no. (%)
ACE-inhibitor/ARB 9(64.3) 10(83.3) n.s.
β-blocker 8(57.1) 7(58.3) n.s.
MRA 3(21.4) 2(16.6) n.s.
Anti platelet therapy 14(100) 12(100) n.s.
Anti coagulation therapy 4(28.6) 3(25.0) n.s.
Statin 10(71.4) 9(75.0) n.s.
SGLT2-inhibitor 2(14.2) 1(8.3) n.s.
ADL – Walkability – no.(%) 13(92.9) 11(91.6) n.s.
There were no significant differences in lesion characteristics and medical therapy.

9. Results
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
There were limitations in the number of patients and follow-
up period to evaluate significant differences in them.
Cardiovascular Intervention and Therapeutics (CVIT)
PCI group (n=14) OMT group (n=12) p value
MACE 3(21.4) 2(16.7) n.s.
all-cause death (%) 0(0) 0(0)
MI (%) 0(0) 2(16.7) .
TLR (%) 3(21.4) 0(0)
Major bleeding (%) 1(7.1) 1(8.3) n.s.
Hospitalization for Heart failure (%) 0(0) 1(8.3) n.s.
MACE (all cause death, MI, TLR), major bleeding, hospitalization for heart failure
Primary endpoint >

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Results
p=0.01
Dept. of Cardiology, Tokyo General Hospital, Japan
CCT 2019 My Best Case Competition Dept. of Cardiology, Tokyo General Hospital, Japan
Dept. of Cardiology, Tokyo General Hospital, Japan
Left Ventricular Ejection Fraction(%)
[%] [ml]
■ PCI ■ Optical Medical Therapy
At 2-years UCG follow-up,
・ LVEDV was significantly
lower in the PCI group.
・ LVEF was not different.
Cardiovascular Intervention and Therapeutics (CVIT)
・ Differences in left ventricular
ejection fraction (LVEF) and left
ventricular end diastolic volume
(LVEDV) after PCI.
Secondary endpoint >
n.s．
n.s.
n.s.
Left Ventricular End Diastolic Volume(ml)
-16.5%
pre post pre post
119.8
96.1
115.1 122.3
55.8 53.2
54.1
52.1
*Moving Average
*
*

11. Summary >
Dept. of Cardiology, Tokyo General Hospital, Japan
Cardiovascular Intervention and Therapeutics (CVIT) 2023
・Our data showed a significant reduction in LVEDV in the PCI group,
but no difference in LVEF.
・There were limitations in the number of patients and follow-up period to
evaluate MACE.
・PCI for RCA CTO may improve diastolic dysfunction and prognosis, so we will
continue to be followed up.