Early Procedural and Health Status Outcomes After Chronic Total Occlusion Angiplasty

A Report From the OPEN-CTO Registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures)

James Sapontis, MBBCH, Adam C. Salisbury, MD, MSC, Robert W. Yeh, MD, MSC, David J. Cohen, MD, MSC, Taishi Hirai, MD, William Lombardi, MD, James M. McCabe, MD, Dimitri Karmpaliotis, MD, Jeffrey Moses, MD, William J. Nicholson, MD, Ashish Pershad, MD, R. Michael Wyman, MD, Anthony Spaedy, MD, Stephen Cook, MD, Parag Doshi, MD, Robert Federici, MD, Craig R. Thompson, MD, Steven P. Marso, MD, Karen Nugent, RRT, Kensey Gosch, MS, John A. Spertus, MD, MPH, J. Aaron Grantham, MD,

OBJECTIVES: This study sought to accurately describe the success rate, risks, and patient-reported benefits of contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

BACKGROUND: In light of the evolving techniques to successfully revascularize CTO lesions, there remains a compelling need to more accurately quantify the success rates, risks, and benefits of these complex procedures.

METHODS: Using a uniquely comprehensive, core-lab adjudicated, single-arm, multicenter registry of 1,000 consecutive patients undergoing CTO PCI by the hybrid approach, we evaluated the technical success rates, complication rates, and raw and adjusted health status benefits at 1 month among successfully as compared to unsuccessfully treated patients.

RESULTS: 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 quality of life 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 quality of life between successful and unsuccessful CTO PCI was 10.8 (95% confidence interval: 6.3 to 15.3; p < 0.001).

CONCLUSIONS: Clarifying the success rates, risks, and benefits of CTO PCI will help to more accurately contextualize the informed consent process for these procedures so that patients with appropriate indications for CTO PCI can more effectively share in the decision to pursue this or other therapeutic options. (J Am Coll Cardiol Intv 2017;10:1523–34) © 2017 by the American College of Cardiology Foundation.

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