{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:59:25Z","timestamp":1785257965095,"version":"3.55.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The relationship between optimal revascularization for chronic total occlusion (CTO) lesions and long\u2010term clinical outcomes in patients with heart failure with or without type 2 diabetes (T2D) remains unclear. Therefore, this study aimed to investigate the association between optimal or nonoptimal CTO percutaneous coronary intervention (CTO\u2010PCI) and long\u2010term adverse clinical outcomes in patients with heart failure with or without T2D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This prospective cohort study included 1591 patients with heart failure who underwent CTO\u2010PCI at Fuwai Hospital between January 2017 and December 2018. Patients were categorized based on CTO\u2010PCI outcomes: failure, suboptimal revascularization, and optimal revascularization. The primary end point was a composite of cardiovascular death and target\u2010vessel myocardial infarction (TVMI), whereas the secondary end point was a composite of all\u2010cause death and myocardial infarction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">During a median follow\u2010up of 3.3\u2009years, 89 (5.6%) cases of cardiovascular death\/TVMI occurred. Patients who received optimal revascularization had significantly lower risks of both cardiovascular death\/TVMI (hazard ratio [HR], 0.45 [95% CI, 0.27\u20130.76]) and all\u2010cause death\/myocardial infarction (HR, 0.53 [95% CI, 0.33\u20130.86]) compared with those with CTO\u2010PCI failure. Subgroup analysis showed that these associations were significant in patients with T2D (cardiovascular death\/TVMI: HR, 0.25 [95% CI, 0.13\u20130.49]; all\u2010cause death\/myocardial infarction: HR, 0.28 [95% CI, 0.15\u20130.53]), but not in those without T2D (cardiovascular death\/TVMI: HR, 0.87 [95% CI, 0.32\u20132.40]; all\u2010cause death\/myocardial infarction: HR, 1.06 [95% CI, 0.40\u20132.85]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Our findings suggest that optimal revascularization during CTO\u2010PCI is associated with a lower risk of adverse cardiovascular events in patients with heart failure, particularly in those with T2D.<\/jats:p>\n                  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