Background: The impact of percutaneous coronary intervention ( PCI ) on chronic total occlusion in patients with well‐developed collaterals is not clear. Methods and Results: A total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [ HR ], 0.177; P =0.039; 95% confidence interval [ CI ], 0.03–0.91) and the composite of total death or myocardial infarction ( HR , 0.298; P =0.017; 95% CI , 0.11–0.80); however, it showed higher hazard of target lesion revascularization ( HR , 3.942; P =0.003; 95% CI , 1.58–9.81) and target vessel revascularization ( HR , 4.218; P =0.001; 95% CI , 1.85–9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization ( HR , 2.868; P =0.027; 95% CI , 1.13–7.31) and target vessel revascularization ( HR =2.62; P =0.022; 95% CI , 1.15–5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction ( HR , 0.263; P =0.017; 95% CI , 0.087–0.790). The mean ejection fraction was improved from 47.8% to 51.6% ( P <0.001) after PCI . Conclusions: In our study, successful revascularization by PCI for chronic total occlusion lesions with well‐developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app–based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean –1.3, SD 2.1 vs mean –0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app–based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000

Rationale: Atherosclerotic plaque is a chronic inflammatory disorder involving lipid accumulation within arterial walls. In particular, macrophages mediate plaque progression and rupture. While PPARγ agonist is known to have favorable pleiotropic effects on atherogenesis, its clinical application has been very limited due to undesirable systemic effects. We hypothesized that the specific delivery of a PPARγ agonist to inflamed plaques could reduce plaque burden and inflammation without systemic adverse effects.