Patient-Reported Factors After PCI for Chronic Total Occlusion

Study Questions:

Do patient symptoms, function, and quality of life (QOL) improve after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO)?

Methods:

Data from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) study were used for the present analysis. The OPEN-CTO study is an investigator-initiated, multicenter, prospectively collected, observational registry of consecutive CTO patients undergoing PCI at 12 US centers. Patients were included if they were scheduled for a CTO PCI, performed by an experienced operator at a participating hospital, and were over the age of 18 years and not pregnant. All procedural angiograms were reviewed at a core laboratory. Primary outcomes of interest, reported at 1-month post-procedure, included patient-reported health status at 1 month using the Seattle Angina Questionnaire, the Rose Dyspnea Questionnaire, and the Patient Health Questionnaire.

Results:

A total of 1,000 consecutive patients (with 1,054 CTO lesions) were included and enrolled in the registry between January 2014 and July 2015. Patients were predominately male and 41% had diabetes. The most common indication for CTO PCI was symptom relief. Technical success was high (86%). In-hospital and 1-month mortality was 0.9% and 1.3%, respectively, and perforations requiring treatment occurred in 48 patients (4.8%). Among those who survived and completed the 1-month interview (n = 947), mean ± SEM Seattle Angina Questionnaire QOL scores improved from 49.4 ± 0.9 to 75.0 ± 0.7 (p < 0.01), mean Rose Dyspnea Scale scores improved (decreased) from 2.0 ± 0.1 to 1.1 ± 0.1 (p < 0.01), and Physician Health Questionnaire (for depression) scores improved (decreased) from 6.2 ± 0.2 to 3.5 ± 0.1 (p < 0.01) at 1 month. After adjusting for baseline differences, the mean group difference in Seattle Angina Questionnaire QOL between successful and unsuccessful CTO PCI was 10.8 (95% confidence interval, 6.3-15.3; p < 0.001).

Conclusions:

The authors concluded that understanding the potential patient-reported benefits of CTO PCI will help to more accurately contextualize the informed consent process for such procedures.

Perspective:

Use of patient-reported factors including general and domain-specific QOL can help individualize treatment to the needs of each patient.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angina Pectoris, Angiography, Angioplasty, Coronary Occlusion, Depression, Diabetes Mellitus, Dyspnea, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Primary Prevention, Quality of Life


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