Study Overview
Objective. To compare the benefit of percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) versus OMT alone on the health status of patients with chronic total occlusions (CTOs).
Design. Multicenter, open-label, prospective randomized control trial.
Setting and participants. 396 patients with at least 1 CTO were assigned to PCI or OMT with a 2:1 randomization ratio.
Main outcome measures. The primary endpoint was the change in health status as assessed by the Seattle Angina Questionnaire (SAQ) between baseline and 12-month follow-up.
Main results. At 12 months, greater improvement of 3 SAQ domains was observed with PCI compared to OMT: angina frequency (5.23, 95% confidence interval [CI], 1.75-8.31, P = 0.0003), physical limitation (P = 0.02), and quality of life (6.62, 95% CI 1.78-11.46, P = 0.0007). More patients in the PCI group than in the OMT group had complete freedom from angina (71.6% vs. 57.8%, P = 0.008). There were no occurrences of periprocedural death or myocardial infarction.
Conclusion. Among patients with stable angina and CTO, PCI leads to significant health status improvement compared with OMT alone.
Commentary
CTOs are present in 15% to 25% of patients undergoing coronary angiogram1 and are associated with increased mortality.2 The benefits of successful CTO intervention observed in multiple large-scale registries include improvement in quality of life, left ventricular function, and survival as well as avoidance of coronary bypass surgery. The main indication for CTO intervention is improvement in quality of life,3 although this has not been confirmed by a randomized controlled trial comparing medical therapy to CTO-PCI.