the success of opening concurrent cto lesion to improve cardiac function trial in patients with multi-vessel disease

Conditions: Chronic Total Occlusion of Coronary Artery; Percutaneous Coronary Intervention; Coronary Artery Disease; Viable Myocardium

Summary: the purpose of this study is to investigate the effect of percutaneous coronary intervention (pci) on cardiac function in multi-vessel disease patients with concurrent chronic total occlusion (cto) lesion.

recruited cto patients will be devided into two groups: those undergoing pci of only the non-cto artery (non-cto pci group), and those undergoing pci of the non-cto artery concurrently with the cto artery (cto-pci group). the primary outcome assessed will be the change in cardiac function evaluated via cmr at a 12-month of follow-up appointment, which will be compared to a baseline measurement. secondary outcomes include occurrence of major cardiac events, cmr-assessed myocardial viability in the cto-supplied territory, and quality of life assessed by seattle angina questionnaire, patient health questionnaire 9 and generalized anxiety disorder scale-7 after 12-month follow-up.

Eligibility criteria:
inclusion criteria: patients should be 18-80 years old; be diagnosed with single cto concurrent with mvd detected using coronary angiography (at least one other major vessel should have exhibited no less than 75% stenosis); present with an lvef above 35% determined using transthoracic echocardiography; present with cto located in an epicardial coronary artery with a reference diameter of ≥ 2.5 mm; and comply all the evaluations and follow-up protocols. exclusion criteria: patients will be excluded if they have suffered from acute myocardial infarction within the previous 3 months; a lesion located in the left main artery (stenosis ≥50%); rheumatic valvular disease; severe arrhythmia; a history of revascularization within the non-cto artery; multiple vessels with cto (more than one cto artery); lesions unsuitable for pci; severely abnormal hematopoietic systems, such as platelet counts \ 700 x 109/l and white blood cell counts \< 3 x 109/l; with active bleeding or bleeding tendencies (active ulcers, short-term ischemic stroke, history of hemorrhagic stroke, intracranial space occupying lesions, recent craniocerebral trauma, and other bleeding or bleeding tendency); severe coexisting conditions, including severe renal function dysfunction \[glomerular filtration rate (gfr) less than 60 ml/min • 1.73 m2), severe hepatic dysfunction \[glutamic-pyruvic transaminase (alt) or glutamic-oxal acetic transaminase (alt) elevated more than three times that of the upper limit of the normal reference\], severe heart failure (nyha classification iii-iv), acute infectious diseases and immune disorders; tumors; surgery within 3 months; a life expectancy less than 12 months; pregnancy or planning to become pregnant; history of allergy or adverse reactions to aspirin, clopidogrel, ticagrelor, stains, contrast material, anticoagulant, or stents. patients will also be excluded if they cannot tolerate dual antiplatelet treatment (dapt); are unable to communicate due to cognitive impairment, auditory, or visual impairment; are participating in another trial for medication or an apparatus and in which the main endpoint has not been reached, or plan to participate in a clinical trial within 12 months of the intervention.

Keywords: chronic total coronary artery occlusion multi-vessel coronary artery disease percutaneous coronary intervention coronary artery disease cardiac function