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Background Successful revascularization of a chronic total coronary occlusion (CTO) impacts coronary physiology of the remote myocardial territory. Purpose This study evaluated the effect of CTO percutaneous coronary intervention (PCI) on changes in absolute perfusion in remote myocardium as assessed by serial [15O]H2O positron emission tomography (PET) perfusion imaging. Methods A total of 164 patients underwent [15O]H2O PET imaging at baseline and 3 months after successful single-vessel revascularization of a CTO to evaluate changes in hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in the remote myocardial territory supplied by both non-target coronary arteries. Results Remote hMBF and CFR improved (2.29±0.67 to 2.48±0.75 mL min–1 g–1 and 2.48±0.76 to 2.74±0.85, respectively) after CTO revascularization (p&amp;lt;0.01 for both). Absolute perfusion indices in the CTO vessel and the remote myocardium showed a positive linear correlation, both before (r=0.75, p&amp;lt;0.01 and r=0.77, p&amp;lt;0.01 for hMBF and CFR, respectively) and after (hMBF: r=0.87, p&amp;lt;0.01 and CFR: r=0.81, p&amp;lt;0.01) CTO PCI. Absolute increases in remote myocardial perfusion were largest in patients with a higher increase in hMBF (βeta [β] 0.56; 95% CI: 0.47–0.65; p&amp;lt;0.01) and CFR (β 0.51 (0.42–0.60); p&amp;lt;0.01) in the CTO territory, independent of clinical, angiographic and procedural characteristics. Furthermore, baseline (hMBF: β −0.24 (−0.39, −0.08); p&amp;lt;0.01 and CFR: β −0.26 (−0.41, −0.11); p&amp;lt;0.01) and post-PCI perfusion (hMBF: β 0.36; (0.27, 0.46); p&amp;lt;0.01 and CFR: β 0.30 (0.21, 0.40); p&amp;lt;0.01) in the CTO vessel were independently associated with the increase in remote myocardial perfusion after CTO PCI. Conclusions An overall increase in remote myocardial perfusion was observed following CTO PCI. Absolute perfusion indices in the remote myocardium showed a positive linear correlation with perfusion in the CTO vessel, before and after CTO revascularization. Importantly, baseline, post-PCI and the absolute increase in perfusion in the CTO territory were independently associated with increases in remote myocardial perfusion after revascularization. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

The effect of chronic total coronary occlusion percutaneous coronary intervention on absolute perfusion in remote myocardium