New Study Extends Key Finding: CTO PCI Improves Heart Function Beyond the LAD

A new study led by Dr. Michael Megaly builds on his earlier landmark work showing that recanalizing chronic total occlusions (CTOs) can meaningfully improve heart function, demonstrating that this benefit is not limited to the left anterior descending (LAD) artery.

In a 2023 study published in The American Journal of Cardiology, Dr. Megaly and colleagues established that among patients with ischemic cardiomyopathy, successful LAD CTO percutaneous coronary intervention (PCI) was associated with a significant improvement in left ventricular ejection fraction (LVEF) of 10.9% at 9 months, an effect that was more pronounced in patients with proximal LAD occlusions on optimal medical therapy. That analysis, drawn from 237 patients undergoing LAD CTO PCI, helped establish the LAD as a territory where recanalization could translate into measurable functional recovery, reinforcing why the LAD had long been considered the primary target for CTO revascularization in patients with reduced ejection fraction.

The open question that followed was whether this benefit was unique to the LAD, given its large myocardial territory, or whether opening CTOs in the right coronary artery or circumflex could offer comparable recovery in patients with cardiomyopathy.

Dr. Megaly's newest study, published in The American Journal of Cardiology, addresses that question directly. The research team evaluated outcomes of non-LAD CTO PCI specifically in patients with cardiomyopathy. The findings indicate that the functional benefit observed in the earlier LAD analysis is not exclusive to that territory, non-LAD CTO PCI can also drive meaningful improvement in LVEF in appropriately selected patients.

Taken together, the two studies reshape a longstanding assumption in the field: that only LAD CTOs warrant consideration for aggressive revascularization in patients with impaired ventricular function. Dr. Megaly's body of work now suggests that territory alone should not determine whether a cardiomyopathy patient is offered CTO PCI; patient selection, occlusion characteristics, and viability assessment matter as much as which vessel is involved.

For patients living with weakened heart function due to a chronic total occlusion, these findings suggest that meaningful recovery of heart function may be possible even when the blocked artery is not the LAD. Whether a given patient stands to benefit depends on a range of factors, including the location and characteristics of the occlusion, overall cardiac function, viability, and comorbidities, and requires careful evaluation by a specialist experienced in complex CTO PCI before any treatment decision is made.

Citations

Megaly M, Zakhour S, Karacsonyi J, Basir MB, Kunkel K, Gupta A, Neupane S, Alqarqaz M, Brilakis ES, Alaswad K. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery. The American Journal of Cardiology. 2023 Apr 15;193:75-82.

Megaly M, Zakhour S, Maki M, Albusoul L, Nakhle A, Karacsonyi J, Mashayekhi K, Rinfret S, Brilakis ES, Alaswad K. Impact of Chronic Total Occlusion PCI in Non-LAD Coronary Arteries on Patients With Cardiomyopathy. The American Journal of Cardiology. 2025 Aug 15;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.