Richard Anderson

🫀 Myocardial perfusion imaging (MPI) is routinely used to assess ischaemia in CTO patients—but does it actually predict outcomes after PCI? This large registry study provides an important answer. ✨ Study at a glance: 🔹 319 patients undergoing CTO-PCI 🔹 65% had moderate–severe ischaemia (≥10% LV) 🔹 Follow-up: 90 days + 5 years ✨ Key findings: 🔹 No difference in hard outcomes between groups: ➡️ all-cause mortality ➡️ MACCE (MI, stroke, HF, CV death) 🔹 At both 90 days and 5 years: 👉 ischaemia burden did NOT predict prognosis 📊 But here’s the nuance: 🔹 Patients with higher ischaemic burden had: ➡️ lower risk of angina hospitalisation at 5 years 👉 Suggesting a greater symptomatic benefit from CTO-PCI ⚠️ Important considerations: 👉 Ischaemia defined globally (≥10% LV), not vessel-specific 👉 Mix of SPECT and PET imaging 👉 No comparison with medical therapy alone 💡 Clinical take-home message: 👉 Ischaemia is not a prognostic marker after CTO-PCI 👉 But it may help identify patients: ✔ more likely to benefit symptomatically ✔ with greater improvement in quality of life 🧠 This reinforces a growing concept: 👉 CTO-PCI should be: symptom-driven, not ischaemia-driven 👉 Imaging should guide selection—but not dictate it 🚨 Bottom line: More ischaemia ≠ better outcomes—only better symptom relief. #Cardiology #CTO #PCI #Ischaemia #CardiacImaging #PET #SPECT #CoronaryArteryDisease #InterventionalCardiology #QualityOfLife 🫀📊