The impact of successful chronic total occlusion percutaneous coronary intervention on clinical outcomes: a tertiary
Maximilian Will1,2,3, Konstantin Schwarz1,2, Simone Aufhauser1,2,3
1Karl Landsteiner University of Health Sciences, Krems, Austria.
Insights
Successful chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) significantly improves angina symptoms and quality of life, though it does not impact mortality rates. This study highlights the symptomatic benefits of successful CTO-PCI in patients with coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- The clinical benefit of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) remains debated due to limited high-quality evidence.
- CTO-PCI aims to improve patient outcomes in coronary artery disease.
Purpose of the Study:
- To evaluate the impact of CTO-PCI on patient symptoms, quality of life, and mortality.
- To compare outcomes between successful and failed CTO-PCI procedures.
Main Methods:
- A retrospective single-center study was conducted in Austria.
- 300 patients undergoing CTO-PCI were analyzed, assessing Canadian Cardiovascular Society (CCS) angina score and Seattle Angina Questionnaire (SAQ) scores.
- Outcomes were compared between successful (n=252) and failed CTO-PCI groups with a median follow-up of 3.4 years.
Main Results:
- Successful CTO-PCI (84% of cases) showed no significant difference in mortality or major adverse cardiovascular events compared to failed procedures.
- Patients with successful CTO-PCI experienced significant improvements in CCS angina scores.
- Successful reopening was linked to significant benefits in SAQ domains, including angina during stressful activity and satisfaction with angina relief.
Conclusions:
- While CTO-PCI does not affect mortality, successful procedures are associated with reduced angina and nitrate use.
- Successful CTO-PCI offers significant symptomatic relief and improved quality of life for patients with coronary artery disease.
Background:
The benefit of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) is controversial because of a lack of high-quality evidence. We aim to evaluate the impact of CTO-PCI on symptoms, quality of life and mortality.
Methods:
We conducted a retrospective single center study of patients with CTO-PCI in a tertiary center in Austria. The study outcomes were Canadian Cardiovascular Society (CCS) angina score, quality of life measured by Seattle Angina Questionnaire (SAQ), and death at median follow up for patients with successful vs. failed CTO-PCI.
Results:
A total of 300 patients underwent CTO-PCI for coronary artery disease, of which 252 (84%) were technically successful with median follow up of 3.4 years. There were no significant differences in in-hospital or all-cause mortality, major adverse cardiovascular event, or stent-related complications between the groups of failed and successful CTO-PCI. Among patients with successful CTO-PCI there was a significant improvement in CCS score, which was not found for the group with failed CTO-PCI. Successful reopening was associated with significant benefits of the SAQ domains of angina with stressful activity [3.7 ± 0.9 vs. 3.1 ± 0.5, p = 0.004, use of nitrates (4.7 ± 0.5 vs. 3.0 ± 1.0) p = 0.005] and satisfaction from angina relief (4.4 ± 1.1 vs. 3.6 ± 1.4 p < 0.001).
Conclusion:
While there was no significant difference in mortality, successful CTO-PCI was associated with greater reduction in angina and the use of nitrates compared to unsuccessful CTO-PCI.
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