Deteriorating cardiac function in patients with chronic total occlusion after successful percutaneous coronary intervention: A case series

Background: Current trials show conflicting results about the effect of successful Percutaneous Coronary Intervention (PCI) on cardiac function in patients with chronic total occlusion (CTO). Various factors contribute to a lack of functional changes after CTO revascularization. Case summary: Here, we present three patients who underwent PCI to treat CTO of the single main branch, all of whom demonstrated a decline in cardiac function detected by Cardiovascular Magnetic Resonance (CMR). Case 1 is a patient with a history of smoking, and transmural myocardial necrosis in the territory of the CTO at baseline. Case 2 exhibites hyperglycemia and persistent ischemia in a non-CTO-supplied territory. Case 3 has a long history of alcohol abuse, likely causing adverse ventricle remodeling after PCI. Discussion: The deterioration observed in these cases does not appear to be associated with the PCI itself. It should be considered that postoperative risk factors attenuate the true benefits of CTO revascularization. This case series also highlights the prudent selection of patients eligible for revascularization by comprehensive assessments and recommends continuous strict management during follow-up to improve the long-term prognosis of patients and the application value of CTO revascularization.