Association Between Revascularization and Quality of Life in Patients With Coronary Chronic Total Occlusions: A
Wael Abuzeid1, Nevena Zivkovic2, Gabby Elbaz-Greener2
1Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Division of Cardiology, Kingston Health Sciences Center, Queen's University, Ontario, Canada.
Insights
Revascularization for coronary chronic total occlusions (CTO) improves quality of life (QoL). This systematic review found that successful procedures, including percutaneous coronary intervention (PCI), generally lead to better QoL outcomes for patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous revascularization for coronary chronic total occlusions (CTO) is increasingly common.
- Quality of life (QoL) is a crucial but under-researched outcome in CTO patients.
- Advances in technology and operator skill have improved CTO revascularization success rates.
Purpose of the Study:
- To systematically review the impact of CTO revascularization on patient QoL.
- To synthesize existing evidence on QoL outcomes following CTO interventions.
- To identify trends in QoL improvements after CTO revascularization.
Main Methods:
- Systematic literature search of Ovid MEDLINE, EMBASE, and EBM reviews (1990-2020).
- Inclusion of studies reporting Seattle Angina Questionnaire QoL subscale (SAQ-QoL) post-CTO revascularization.
- Risk of bias assessment using ROBINS-I and Cochrane tools.
Main Results:
- 21 studies met inclusion criteria, categorized by patient population and intervention.
- CTO revascularization (PCI or CABG) significantly improved SAQ-QoL compared to baseline.
- Successful PCI for CTO vessels showed significant QoL improvement compared to unsuccessful procedures.
Conclusions:
- CTO revascularization is generally associated with improved QoL.
- Despite limited high-quality randomized trials, evidence suggests a positive trend in QoL post-intervention.
- Further research is needed to solidify QoL benefits and optimal treatment strategies.
Background:
Percutaneous revascularization of coronary chronic total occlusions (CTO) has increased due to advances in technology and operator expertise. Quality of life (QoL) remains an important but understudied outcome following CTO revascularization. Our aim is to conduct a systematic review of the impact of CTO revascularization on QoL.
Methods:
We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from January 1st, 1990 to May 17th, 2020. Studies reporting on the following QoL metrics post CTO revascularization were included: QoL subscale of the Seattle Angina Questionnaire (SAQ-QoL). The ROBINS-I tool and Cochrane risk of bias tool were used to critically assess for risk of bias.
Results:
We identified 1476 articles, of which 21 articles met inclusion criteria. Three categories of studies were identified with distinct patient populations. In the first category (1 study), CTO patients treated with either PCI or CABG compared to medical therapy had a significant improvement in SAQ-QoL compared to baseline (PCI 54.2 to 74.3; CABG 56.1 to 78.0; p < 0.05). In the second category (1 study), CTO patients compared to non-CTO patients had similar improvements in SAQ-QoL post PCI (CTO baseline 53.2 to 80.3; non-CTO baseline 56.5 to 80.6; p < 0.05). Finally, a third category with only CTO patients treated with PCI to the CTO vessel included 19 studies, all of which on average showed a significant improvement in SAQ-QoL post successful PCI, compared to non-successful PCI.
Conclusion:
Despite the limited literature, revascularization of CTO vessel was generally associated with improvement in QoL.
Brief Summary:
Quality of life (QoL) is an important but understudied outcome following CTO revascularization. We conducted a systematic review of the impact of CTO revascularization on QoL. Despite the limitations of a lack of enough randomized control trials and the small number of studies, our systematic review highlights a trend of improvement in QoL indices after revascularization of CTO.
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