Can Opening a Blocked Artery Help a Weakened Heart Recover? Dr. Megaly Addresses the Evidence at CRT 2026
At Cardiovascular Research Technologies (CRT 2026) in Washington, DC, Dr. Michael Megaly, interventional cardiologist at Integris Health Heart Hospital in Oklahoma City, served as invited faculty and delivered the lecture "CTO PCI and LVEF: What Do We Know?" The talk addressed one of the most debated questions in interventional cardiology: whether reopening a completely blocked coronary artery can help a weakened heart pump better. The lecture is also available to physicians on VuMedi.
The Clinical Question
A chronic total occlusion (CTO) is a coronary artery that has been completely blocked for three months or longer. Many patients with CTOs also have a reduced left ventricular ejection fraction (LVEF), the percentage of blood the heart pumps out with each beat. When heart muscle goes without adequate blood flow for a long time, it can enter a protective "hibernating" state. The muscle is still alive, but it barely contracts. The central question is whether restoring blood flow can wake that muscle up.
Why the Evidence Has Seemed Mixed
Dr. Megaly reviewed the large studies behind the debate. A German registry of roughly 8,000 patients who underwent stenting found that patients with the weakest hearts (LVEF below 40%) had the largest improvement, a median gain of about 6 percentage points. That improvement was linked to better long-term survival. However, major randomized trials, including STICH and REVIVED-BCIS2, found no overall benefit from revascularization in patients with weakened hearts.
Dr. Megaly explained why the findings disagree. Those trials mostly enrolled patients without significant symptoms and excluded patients with recent heart attacks. They also included many narrowed arteries that were not actually restricting blood flow. Opening an artery that is not starving the heart of blood should not be expected to improve heart function.
Why CTOs Are Different
CTOs are a distinct situation. Pressure-wire studies show that CTOs severely restrict blood flow even when the heart has grown its own natural bypass channels. In one study, flow measurements rose from an average of 0.45 to 0.91 after the artery was reopened, where values below 0.80 indicate significant restriction. After a successful procedure, the artery beyond the blockage also kept widening over the following months.
Dr. Megaly's Own Research
Dr. Megaly presented findings from his own published studies. His meta-analysis of cardiac MRI studies showed that previously weak heart muscle segments contracted about 12% better after successful CTO PCI. His study of blockages in the left anterior descending (LAD) artery found an average LVEF gain of nearly 11 percentage points. A follow-up study of other arteries also found meaningful gains: about 6 points for the circumflex artery and nearly 10 points for the right coronary artery.
Recovery Takes Time
Improvement is not immediate. Data reviewed in the lecture showed that the share of patients whose hibernating muscle recovered grew from 54% at three months to 72% at one year. In areas with partial scarring, more than a third of the recovery happened between six months and two years. Heart function after CTO PCI is therefore best reassessed over time, not judged in the first few weeks.
What This Means for Patients
Not every patient improves, and predicting who will is an active area of research. The evidence does indicate that carefully selected patients can see meaningful recovery after successful revascularization. Those patients have a CTO that truly limits blood flow and heart muscle that is still viable. CTO PCI is among the most technically demanding procedures in cardiology, and procedural success depends heavily on operator experience.
Citation
Megaly M. CTO PCI and LVEF: What Do We Know? Invited lecture, Cardiovascular Research Technologies (CRT 2026), Washington, DC, March 2026.
Available on VuMedi.
Megaly M, Brilakis ES, Abdelsalam M, et al. Impact of Chronic Total Occlusion Revascularization on Left Ventricular Function Assessed by Cardiac Magnetic Resonance. JACC Cardiovasc Imaging. 2021;14(6):1176-1185.
Megaly M, Zakhour S, Karacsonyi J, et al. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery. Am J Cardiol. 2023;193:75-82.
Megaly M, Zakhour S, Maki M, et al. Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy. Am J Cardiol. 2025;249:9-15.
Dr. Michael Megaly specializes in complex and high-risk coronary interventions, chronic total occlusion (CTO) PCI, surgical turn-downs, complex peripheral artery disease, and limb salvage at Integris Health Heart Hospital in Oklahoma City.
Comments