TOPLINE:
Symptom status and quality of life (QoL) improved significantly in patients with coronary-artery chronic total occlusions (CTO) successfully opened by percutaneous coronary intervention (PCI) compared with such patients with unsuccessful CTO-PCI or on medical management only.
METHODOLOGY:
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Most patients with CTO are treated with optimal medical therapy (OMT) aimed at alleviating angina symptoms and improving clinical outcomes.
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Lack of robust supporting evidence is a main obstacle to broader adoption of CTO-PCI in such patients unresponsive to OMT.
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The current analysis comprised seven prospective studies, including three randomized trials and four observational studies, that featured a total of 2500 CTO patients and reported QoL outcomes using the well-validated Seattle Angina Questionnaire (SAQ), whose metrics also include angina frequency and physical limitation.
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Outcomes of patients with successful CTO-PCI were compared to those with unsuccessful CTO-PCI or who were managed with OMT without an attempt at revascularization.
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The primary outcome was SAQ-questionnaire angina frequency (SAQ-AF); the mean follow-up was 14.8 months.
TAKEAWAY:
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Results on the SAQ-AF in 5 studies showed significant improvement in the successful CTO-PCI group by 12.9 (95% CI, 7.1 – 19.8) survey points for a standardized mean difference (SMD) of 0.54 (95% CI, 0.21 – 0.92, P =.002) compared with the group without successful CTO-PCI.
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Age, sex, and medications such as calcium channel blockers, beta-blockers, and nitrates were not associated with outcomes differences
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There were corresponding improvements in the SAQ-QoL domain of 14.9 (95% CI, 7.7 – 22.5) survey points for an SMD of 0.41 (95% CI, 0.25 – 0.61, P <.001); and in the SAQ physical limitation domain of 9.7 (95% CI, 3.5 – 16.2) survey points for an SMD of 0.42 (95% CI, 0.24 – 0.55, P < .001).
IN PRACTICE:
Such positive information on improved symptoms and other QoL measures associated with CTO-PCI “is essential for physicians when they discuss the potential benefits of this procedure before deciding treatment strategies,” the report states.
SOURCE:
The study was conducted by Selcuk Kucukseymen, MD, University Hospital Careggi, Florence, Italy, and colleagues. It was published July 20 in JAMA Network Open.
LIMITATIONS:
Each included study carried inherent selection bias associated with patient characteristics, CTO site, and time to last SAQ assessment. Improvements in SAQ results were expressed in absolute numbers rather than by achievement of prespecified thresholds for the SAQ domains. Some results may have been influenced by the limited number of studies that were included and their unmeasured confounders.
DISCLOSURES:
Kucukseymen reports receiving a grant from European Association of Percutaneous Cardiovascular Interventions (EAPCI). Disclosures for the other authors are in the original report.
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