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Successful PCI of Chronic Total Occlusions and Quality of Life
Quick Takes
- This systematic review and meta-analysis reports an improvement in health status–related life quality in patients receiving a successful CTO-PCI.
- These findings support CTO-PCI in symptomatic patients unresponsive to optimal medical treatment and may help physicians in their decision-making process when treating this high-risk group of patients.
- Of note, similar to PCI in other chronic coronary syndromes, the only proven benefit of CTO-PCI appears to be symptom relief with no improvement in hard points.
Study Questions:
What is the association of successful chronic total occlusion percutaneous coronary intervention (CTO-PCI) with quality of life?
Methods:
The investigators searched PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane databases to identify randomized trials and observational studies specifically addressing quality-of-life domains of Seattle Angina Questionnaire (SAQ) from January 2010 to June 2022. Studies included reporting SAQ metrics such as angina frequency, physical limitation, and quality of life, before and after CTO-PCI. Data were extracted by three independent reviewers. The primary outcome was angina frequency; physical limitation and quality of life were assessed as secondary outcomes. The present study was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, in which fixed-effect or random-effect models with generic inverse-variance weighting depending on statistical homogeneity were applied.
Results:
Seven prospective randomized or observational studies (2,500 patients) were included, with a mean (standard deviation [SD]) participant age of 61.2 (2.1) years. CTO-PCI was associated with significantly improved quality-of-life metrics during a mean (SD) follow-up of 14.8 (16.3) months. In patients with successful procedures, angina episodes became less frequent (mean [SD] difference for SAQ angina frequency of 12.9 [3.1] survey points [95% CI, 7.1-19.8 survey points]; standardized mean difference was 0.54 [95% CI, 0.21-0.92]; p = 0.002; I2 = 86.4%) and they experienced less physical activity limitation (mean [SD] difference for SAQ physical limitation of 9.7 [6.2] survey points [95% CI, 3.5-16.2 survey points]; standardized mean difference was 0.42 [95% CI, 0.24-0.55]; p < 0.001; I2 = 20.9%), and greater quality-of-life domain (mean [SD] difference for SAQ quality of life of 14.9 [3.5] survey points [95% CI, 7.7-22.5 survey points]; standardized mean difference was 0.41 [95% CI, 0.25-0.61]; p < 0.001; I2 = 58.8%) compared with patients with optimal medical therapy or failed procedure. Furthermore, follow-up duration (point estimate, 0.03; 95% CI, 0.01-0.04; p = 0.01) was associated with a significant decrease in angina frequency in meta-regression analysis.
Conclusions:
The authors report that successful CTO-PCI procedures were associated with improved quality-of-life parameters compared with patients on optimal medical therapy or after failed CTO-PCI.
Perspective:
This systematic review and meta-analysis reports an improvement in health status–related life quality as assessed by the validated SAQ metrics in patients receiving a successful CTO-PCI. These findings support CTO-PCI in symptomatic patients unresponsive to optimal medical treatment and may help physicians in their decision-making process when treating this high-risk group of patients. Of note, similar to PCI in other chronic coronary syndromes, the only proven benefit of CTO-PCI appears to be symptom relief with no improvement in hard points. All these patients should also be on optimal guideline-directed medical therapies.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD
Keywords: Angina Pectoris, Chronic Disease, Coronary Occlusion, Exercise Tolerance, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Quality of Life, Secondary Prevention
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