Patient-Reported Factors After PCI for Chronic Total Occlusion
Do patient symptoms, function, and quality of life (QOL) improve after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO)?
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.
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).
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.
Use of patient-reported factors including general and domain-specific QOL can help individualize treatment to the needs of each patient.
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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