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Health Status Benefits of Successful Chronic Total Occlusion Revascularization Across the Spectrum of Left
Yevgeniy Khariton1, Sophia Airhart2, Adam C Salisbury1
1Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri.
Insights
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) significantly improves health status in patients with reduced left ventricular ejection fraction (LVEF). While improvement is less pronounced in severe LVEF reduction, all patients benefit from CTO-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) trials have historically excluded patients with cardiomyopathy.
- The impact of CTO-PCI on health status in patients with reduced left ventricular ejection fraction (LVEF) remains unclear compared to those with normal LVEF.
Purpose of the Study:
- To assess the association between successful CTO percutaneous coronary intervention (PCI) and health status.
- To compare health status improvements in patients undergoing CTO-PCI across different categories of left ventricular ejection fraction (LVEF).
Main Methods:
- Utilized data from the OPEN-CTO Registry, assessing health status with Seattle Angina Questionnaire (SAQ) and Rose Dyspnea Scale.
- Classified 762 patients into three LVEF groups: normal (≥50%), mild-moderate (30%-49%), and severe (<30%).
- Employed hierarchical multivariable regression to compare 1-year outcomes between LVEF groups.
Main Results:
- All LVEF groups showed improvement in SAQ Summary scores post-CTO-PCI.
- Patients with severely reduced LVEF (<30%) had significantly less improvement in SAQ Summary Score and Rose Dyspnea Scale compared to those with normal LVEF (≥50%).
- Health status improvement was comparable between patients with normal LVEF (≥50%) and mild-moderate LVEF reduction (30%-49%).
Conclusions:
- Successful CTO-PCI leads to substantial health status improvements across all LVEF categories.
- Patients with severely reduced LVEF experience less pronounced health status gains compared to those with normal LVEF following CTO-PCI.
- CTO-PCI is a valuable intervention for improving health status in patients with and without cardiomyopathy.
Objectives:
This study sought to describe the association between chronic total occlusion (CTO) revascularization (CTO percutaneous coronary intervention [PCI]) and health status in patients with and without cardiomyopathy.
Background:
Prior PCI trials for cardiomyopathy have excluded CTO patients. Whether patients with reduced left ventricular ejection fraction (LVEF) receive similar health status benefit from CTO-PCI compared with patients with normal LVEF is unclear.
Methods:
We assessed health status change, using the Seattle Angina Questionnaire (SAQ) Summary, SAQ Angina Frequency, and Rose Dyspnea Scale scores, among patients undergoing successful CTO PCI in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) Registry. Participants were classified by LVEF (normal, ≥50%; mild-moderate, 30% to 49%; and severe, <30%), with higher SAQ and lower Rose Dyspnea Scale scores indicating better health status. Differences in 1-year outcomes were compared using hierarchical multivariable regression.
Results:
Of 762 patients, 506 (66.4%), 193 (25.3%), and 63 (8.3%) had normal, mild-moderate, and severely reduced LVEF. SAQ Summary score improvements were observed in each group (27.1 ± 20.4, 26.7 ± 21.2, and 20.3 ± 18.1, respectively). Compared with patients with LVEF ≥50%, those with LVEF <30% had less improvement in SAQ Summary Score (-5.2 points; 95% confidence interval: -9.0 to -1.5; p = 0.01) and Rose Dyspnea Scale (+0.5 points; 95% confidence interval: 0.1 to 0.8; p = 0.01), with no difference in odds of angina (odds ratio: 1.3; 95% confidence interval: 0.6 to 3.0; p = 0.48). Health status improvement was similar between patients with LVEF ≥50% and LVEF 30% to 49%.
Conclusions:
Although health status improvement was less in patients with severely reduced LVEF compared with those with normal LVEF, each group experienced large health status improvements after CTO-PCI.
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