[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-456419-105":59,"doc-detail-456419-en":134},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":127,"head_meta":129,"extra_data":131,"updated_unix":133},105,"en","selecting-the-right-patient-for-cto-pci-is-ischaemia-still-the-key","Selecting the right patient for CTO-PCI - is ischaemia still the key?","","Editorial analyzing how to select patients for chronic total occlusion percutaneous coronary intervention (CTO-PCI), weighing procedural success against risks and comparing outcomes with optimal medical therapy. Retrospective and systematic-review data suggest mortality and major adverse event reductions, yet randomized trials show limited or inconsistent mortality benefit and variable symptom effects. The text emphasizes limitations such as residual confounding and trial bias, highlights imaging-based decision frameworks, and notes the role of non-invasive perfusion imaging, including PET, to better define anatomy, inducible ischemia, viability, and likely benefits.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/selecting-the-right-patient-for-cto-pci-is-ischaemia-still-the-key/456419/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/selecting-the-right-patient-for-cto-pci-is-ischaemia-still-the-key/456419.png","ImageObject",300,407,{"name":92,"@type":93},"Blue Pony","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"Why is selecting the right patient for CTO-PCI clinically challenging?","Question",{"text":112,"@type":113},"CTO-PCI is described as both clinically and technically challenging, with high procedural success in experienced hands but measurable risks such as mortality and coronary perforation. Patient selection and study design differences also affect observed outcomes.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Do observational studies and systematic reviews show benefit of CTO-PCI over optimal medical therapy?",{"text":117,"@type":113},"Yes. The editorial reports that attempted CTO-PCI in observational data is associated with reductions in all-cause mortality, cardiac death, and major adverse cardiovascular events compared with optimal medical therapy alone, and better outcomes when CTO-PCI is successful.",{"name":119,"@type":110,"acceptedAnswer":120},"What do randomized trials suggest about CTO-PCI compared with conservative strategies?",{"text":121,"@type":113},"Randomized revascularization trials are reported not to demonstrate a consistent mortality benefit, and symptom improvement results are equivocal. The EUROCTO trial shows similar major adverse events at one year but clinically meaningful health status improvement, while DECISION-CTO finds no superiority for routine CTO-PCI plus optimal medical therapy.",{"name":123,"@type":110,"acceptedAnswer":124},"How does the editorial frame the role of ischemia testing and imaging in CTO-PCI decisions?",{"text":125,"@type":113},"It argues ischemia alone is not enough and shifts toward a symptom-first paradigm supported by non-invasive imaging. Consensus guidance highlights imaging to define coronary anatomy, quantify inducible ischemia, assess viability, guide planning, and predict the impact on LV remodeling and residual ischemia, with myocardial perfusion imaging and PET discussed as promising tools.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},456419,1790791850,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":52,"preview_page_count":4},962090760266,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Selecting the right patient for CTO-PCI: is ischaemia still the key?  \nAlaaeddine El Ghazawi, Maria Alwan, and Mouaz Al-Mallah  *  \nHouston Methodist Academic Institute, Weill Cornell Medicine, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower—Suite 1801, Houston, TX 77030, USA  \nOnline publish-ahead-of-print 8 January 2026  \nThis editorial refers to ‘Implication of myocardial perfusion abnormalities on clinical outcomes in patients treated with percutaneous coronary intervention for chronic total occlusions’, by J.B. Henningsen et al., [https://doi.org/10.1093/](https://doi.org/10.1093/)[ ](https://doi.org/10.1093/)[ehjimp/qyaf137.](ehjimp/qyaf137.)  \nThe management of chronic total occlusion (CTO) remains clinically and technically challenging. With recent advances, CTO percutaneous coronary intervention (CTO-PCI) has achieved procedural success rates exceeding 80–90% when performed by experienced operators.1 However, CTO-PCI c∼arries a reported mortality of 1.3% and coronary  \nperforation rates of 4.8% .2 Observational studies suggest that patients with CTO revascularization experience better outcomes than those on optimal medical therapy (OMT), which has prompted increased consideration of CTO-PCI. A recent systematic review of 29 studies with adequate representation of older adults, out of which 28 were observational, demonstrated that attempted CTO-PCI was associated with reductions in all-cause mortality, cardiac death, and major adverse cardiovascular events compared with OMT alone. Additionally, cardiac death and all-cause mortality were lower in successful CTO-PCI vs. failed CTO-PCI.3  \nHowever, randomized trials of revascularization in general have not demonstrated a mortality benefit, and findings regarding symptom improvement have been equivocal. Thus, the apparent advantages seen in retrospective studies may be in part due to residual confounding, as patients with successful procedures may differ systematically from those with failed attempts or those not selected for intervention. From a functional standpoint, both the evaluating xience and left ventricular function in PCI on occlusions after STEMI and randomized trial to assess regional left ventricular function after stent implantation in chronic total occlusion trials showed no significant improvement in left ventricular (LV) function with CTO-PCI compared with OMT alone.4 From a prognostic standpoint, the EUROCTO (randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total occlusions) trial demonstrated similar major adverse events with CTO-PCI and OMT at 1 year, however clinically meaningful improvement in health status was observed with CTO-PCI.5 In contrast, the larger DECISION-CTO (Drug-Eluting  \nStent Implantation vs. Optimal Medical Treatment in Patients With Chronic Total Occlusion) trial showed no superiority of routine CTO-PCI plus OMT over OMT alone in improving symptoms or reducing major cardiovascular outcomes.6 An analysis of patients with CTO from the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial demonstrated that an initial invasive strategy did not reduce mortality, and was associated with more procedural myocardial infarctions (MI), fewer spontaneous MI, and significantly greater improvements in angina and dyspnoea-related quality of life compared with a conservative approach. In an observational comparison of the ISCHEMIA trial, successful CTO revascularization (whether with PCI or CABG) was associated with better quality of life and a higher likelihood of reduced cardiovascular death or MI—although the absolute difference was modest—but not with lower all-cause mortality compared with conservative management.7 However, results of the trials mentioned above should be interpreted in the context of important limitations, including crossover between treatment arms, potential selection ","cbCaigAx0xn7RuCr","https://ap.wps.com/l/cbCaigAx0xn7RuCr","pdf",442021,"English","# Editorial overview\n## Outcomes of CTO-PCI vs optimal medical therapy\n## Randomized trial evidence and limitations\n## Imaging for CTO-PCI decisions\n## Role of non-invasive perfusion imaging (MPI)","[{\"question\":\"Why is selecting the right patient for CTO-PCI clinically challenging?\",\"answer\":\"CTO-PCI is described as both clinically and technically challenging, with high procedural success in experienced hands but measurable risks such as mortality and coronary perforation. Patient selection and study design differences also affect observed outcomes.\"},{\"question\":\"Do observational studies and systematic reviews show benefit of CTO-PCI over optimal medical therapy?\",\"answer\":\"Yes. The editorial reports that attempted CTO-PCI in observational data is associated with reductions in all-cause mortality, cardiac death, and major adverse cardiovascular events compared with optimal medical therapy alone, and better outcomes when CTO-PCI is successful.\"},{\"question\":\"What do randomized trials suggest about CTO-PCI compared with conservative strategies?\",\"answer\":\"Randomized revascularization trials are reported not to demonstrate a consistent mortality benefit, and symptom improvement results are equivocal. The EUROCTO trial shows similar major adverse events at one year but clinically meaningful health status improvement, while DECISION-CTO finds no superiority for routine CTO-PCI plus optimal medical therapy.\"},{\"question\":\"How does the editorial frame the role of ischemia testing and imaging in CTO-PCI decisions?\",\"answer\":\"It argues ischemia alone is not enough and shifts toward a symptom-first paradigm supported by non-invasive imaging. Consensus guidance highlights imaging to define coronary anatomy, quantify inducible ischemia, assess viability, guide planning, and predict the impact on LV remodeling and residual ischemia, with myocardial perfusion imaging and PET discussed as promising tools.\"}]","Selecting the right patient for CTO-PCI - is ischaemia still the key? | PDF",1790745975]