Patient-Reported Health Status and Clinical Outcomes After CTO-PCI Versus Optimal Medical Therapy: A 12-Month...

Background/Objectives: Chronic total coronary occlusion (CTO) is frequently associated with persistent angina, functional limitation, and impaired health-related quality of life. Although CTO percutaneous coronary intervention (CTO-PCI) has improved technically, its clinical value is best assessed through patient-reported outcomes (PROs) and patient-centered clinical endpoints. This study evaluated the association between CTO-PCI plus optimal medical therapy (OMT) and 12-month patient-reported and clinical outcomes compared with OMT alone. Methods: This single-center, non-randomized retrospective observational cohort analysis included 251 patients with chronic coronary syndrome and angiographically confirmed CTO. Patients were managed with either a CTO-PCI + OMT strategy (n = 153) or OMT alone (n = 98). The analysis used routinely collected clinical, angiographic, echocardiographic, procedural, and follow-up data, complemented by patient-reported Seattle Angina Questionnaire (SAQ) data obtained after written informed consent. The overall SAQ assessment was considered the primary patient-reported framework, and SAQ Angina Frequency was defined as the principal symptom-specific domain for adjusted comparative analysis. Propensity-score overlap weighting was used as a sensitivity analysis to address measured baseline imbalance and treatment-selection bias. Secondary outcomes included Canadian Cardiovascular Society angina class, left ventricular ejection fraction, cumulative 12-month cardiovascular rehospitalization, and survival. Results: The complete-case SAQ population included 217 patients: 136 in the CTO-PCI + OMT group and 81 in the OMT group. Thirty-four patients lacked complete 12-month SAQ data: 24 died before SAQ reassessment, and 10 were lost to SAQ follow-up. SAQ Angina Frequency improved in both groups, from 70.81 ± 17.97 to 92.35 ± 12.37 in the CTO-PCI + OMT group and from 63.09 ± 20.10 to 83.09 ± 15.14 in the OMT group. In the multivariable ANCOVA model, CTO-PCI + OMT was associated with higher 12-month SAQ Angina Frequency compared with OMT alone (β = 7.07 points; 95% CI, 3.36-10.79; p < 0.001). This finding remained consistent in the propensity-score overlap-weighted sensitivity analysis adjusted for baseline SAQ Angina Frequency (β = 6.55 points; 95% CI, 2.39-10.70; p = 0.002). Cardiovascular rehospitalization was observed in 11 of 153 patients (7.2%) in the CTO-PCI + OMT group and in 19 of 98 patients (19.4%) in the OMT group, corresponding to lower odds of cumulative 12-month rehospitalization (OR = 0.32; 95% CI, 0.15-0.71; p = 0.005). The rehospitalization endpoint was analyzed as a cumulative binary outcome rather than as a time-to-event outcome. Overall survival estimates were 92.0% and 87.4%, respectively, with 12 deaths in each group (log-rank p = 0.225). Because only 24 deaths were recorded, the study was underpowered to evaluate mortality differences. Conclusions: In selected patients with chronic coronary syndrome and CTO, CTO-PCI + OMT was associated with greater improvement in disease-specific health status, particularly SAQ Angina Frequency, compared with OMT alone. CTO-PCI + OMT was also associated with lower cumulative 12-month cardiovascular rehospitalization, although this secondary finding should be interpreted cautiously because of the non-randomized retrospective design, modest event numbers, lack of time-to-event rehospitalization data, and potential expectation- and care-related biases. Survival analyses were underpowered and should not be interpreted as evidence of either prognostic benefit or absence of benefit. These findings support consideration of CTO-PCI as a patient-centered therapeutic option in carefully selected symptomatic patients, while acknowledging residual confounding by indication and the open-label study design.