In patients with NSTEMI, multivessel disease, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid-term clinical outcomes, whereas additional revascularization of non-CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized.
In this multicenter retrospective cohort of NSTEMI patients with multivessel disease and CTO, only a minority had successful CTO recanalization.
MACCE incidence was significantly lower in the CR-CTO group than in the ICR-CTO group.
MACE incidence was significantly lower in the CR-CTO group than in the ICR-CTO group.
After multivariable adjustment, successful CTO recanalization with complete revascularization was independently associated with lower risk of MACCE.
After multivariable adjustment, successful CTO recanalization with complete revascularization was independently associated with lower risk of MACE.
Among patients without successful CTO recanalization, additional revascularization of non-CTO lesions was not associated with improved outcomes.
The authors conclude that CTO revascularization status may warrant specific consideration when evaluating revascularization strategies in NSTEMI patients with MVD.
This study looked at patients who had a certain type of heart attack (NSTEMI), blockages in several heart arteries, and at least one artery that was completely blocked for a long time (a chronic total occlusion, or CTO). Researchers compared 119 patients whose CTO was successfully reopened, along with their other blockages treated, to 513 patients whose CTO was not successfully reopened. They followed patients for about 1.5 years on average. Patients with a successfully reopened CTO had far fewer major cardiovascular events. Major adverse cardiac and cerebrovascular events happened in 11.8% versus 28.5%, and major adverse cardiac events in 7.6% versus 24.2%. After accounting for other differences between patients, reopening the CTO was still linked to a roughly 65% lower risk of the broader outcome and a 74% lower risk of the narrower one. In patients whose CTO was not reopened, treating the other blocked arteries did not appear to improve outcomes. This research suggests that whether a CTO is successfully reopened may matter when doctors consider treatment strategies for these patients. However, the study was retrospective and observational, so it cannot prove that reopening the CTO caused the better outcomes. Patients whose procedures succeeded may also have differed in other ways. Larger, prospective studies would be needed to confirm these results.
Liu W, Li Y, Qin W, Gao J, Liu B, Rao C, et al.. (2026). Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease.. Clinical cardiology. https://doi.org/10.1002/clc.70491