Courtesy of Dr. Carlos Fava.

The presence of CTO hovers around 15, 20% in coronary angiographies of patients with chronic stable angina, but only 5% receive percutaneous coronary intervention (PCI).

One of the obstacles to percutaneous revascularization is the lack of relevant studies justifying it, though we do have different comparative studies that improve symptoms, ventricular function and survival rate.

This is a multicenter, open and controlled study randomized 2:1 comparing PCI with optical medical treatment in 259 CTO patients vs. optimal medical treatment alone in137 CTO patients.

Read also: EuroPCR 2018 | Consistent CTO Study: Rechanneling with Current Techniques and SYNERGY Stents.

Clinical characteristics in both groups were similar: mean age was 65, 31.6% were diabetic and 52% presented multivessel disease.

Successful PCI rate was 86.6%. The anterograde approach was used in 35% of patients, the average number of stents was 2 and the average stent length was 65 mm.

In hospital complications rate was 2.9% (4 cardiac tamponade, 2 vascular complications requiring surgery and 5 hemorrhages that required transfusion). There were no deaths.

Read also: In which patients should we attempt chronic total occlusion rechanneling?

At one year follow up, the TMO group received more drugs. Survival free of angina was higher in the PCI group (71.6% vs 57.8%, p=0.008) as was the SAQ scale (5.23, 95% confidence interval 1.75; 8.71; p= 0.003), quality of life (6.62, 95% confidence interval 1.78–11.46; p= 0.007) and physical activity. MACE rate was similar.

Conclusion

PCI in CTO leads to significant health improvement in patients with chronic stable angina compared against patients receiving only optimal medical treatment.

Commentary

This study does not bring along important information, and even though PCI might not show differences in mortality at one year (which is quite predictable), it does improve quality of life, and it also reduces medication, bringing more comfort to patients with low ─not mortality-related─ periprocedural complications rate.  

In addition, we must admit that we have gone a long way in the CTO arena, mostly as regards the development of new devices, guidelines, and the growing experience of operators and centers.

Let us remember it is crucial for us physicians to offer relief from pain and to improve quality of life. PCI in CTO has many benefits other than mortality, since it is usually performed in low risk patients.

Gentileza del Dr. Carlos Fava.

Original title: A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. the EUROCTO trial.

Reference: Gerald S.Werner European Heart Journal (2018) 0, 1–10.

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