PCI outclasses OMT for chronic total coronary occlusion

Percutaneous coronary intervention (PCI) performs better than optical medical therapy (OMT) in improving quality of life (QoL), angina frequency, and the Seattle Angina Questionnaire (SAQ) summary score in patients with a single chronic total coronary occlusion (CTO), reports a study.

Some 518 patients with a single CTO and no other significant coronary lesion were identified from two randomized controlled trials, EUROCTO and DECISION-CTO, which had compared PCI with OMT. The randomization to PCI or OMT was 1:1 in DECISION and 2:1 in EUROCTO.

The investigators assessed clinical status using the SAQ summary score at baseline and after 12 months. They also monitored clinical events for 3 years.

Most patients (92.2 percent) underwent PCI successfully. Intention-to-treat analysis revealed the superiority of PCI to OMT for the change of angina frequency scores between baseline and follow-up (12.2 vs 8.6; p=0.009), QoL (19.5 vs 11.3; p<0.001), and the SAQ summary score (13.8 vs 8.5; p<0.001).

“For physical limitation, the difference was just at the level of the Bonferroni correction for multiple tests (p=0.01),” the investigators said.

A wide variability of changes was observed in SAQ scores. For QoL, a low baseline score and the assignment to PCI were major determinants for a significant improvement. On the other hand, gender, diabetes, or lesion complexity showed no significant influence.

Furthermore, cardiac death or nonfatal myocardial infarction were comparable between groups during a mean follow-up of 3.1 years (OMT vs PCI: 2.7 percent vs 5.1 percent; p=0.17). Likewise, the rates of stroke or hospitalization for bleeding showed no significant between-group difference, and only target lesion revascularizations were more frequent in the OMT group (18.8 percent vs 10.6 percent; p=0.005).

“In this post hoc analysis … PCI achieved better improvement in QoL, angina frequency, and the SAQ summary score than OMT with no signal of excess harm regarding clinical endpoints,” the investigators said.