Key result
An invasive strategy significantly improved quality of life compared to medical therapy at 3 months (SAQ-7 score 89.02 vs 72.3, p=0.0001) in symptomatic patients with single-vessel CTO.
Why the study?
Indications for an invasive strategy in coronary chronic total occlusion remain controversial, with limited data on its role in improving quality of life.
Does an invasive strategy improve quality of life compared to a medical strategy in symptomatic patients with single-vessel coronary chronic total occlusion?
RCT (n=140)
randomized
Does an invasive strategy improve quality of life compared to a medical strategy in symptomatic patients with single-vessel coronary chronic total occlusion?
Absolute Event Rate: 89.02% vs 72.3%
p-value: p=0.0001
In symptomatic patients with single-vessel chronic total occlusion, an invasive recanalisation strategy significantly improves quality of life at 3 and 12 months compared to medical therapy alone.
Background. Coronary chronic total occlusion (CTO) is a common finding during routine coronary angiography. Despite significant progress in the technical success rate of CTO percutaneous coronary intervention over the last decade, indications for an invasive strategy are still controversial. To date, there is limited data on the role of invasive strategy in patients with CTO in improving the quality of life (QoL).Aim. To compare the QoL changes in patients with coronary artery disease with a single-vessel coronary CTO randomised to invasive or medical strategies.Methods. The study included 140 symptomatic patients with single-vessel CTO, who were randomised to either invasive or medical strategies. The QoL was then analysed using the Seattle Quality of Life Questionnaire (SAQ-7), EQ-5D-5L and the Rose Dyspnea Scale at baseline, after 3 and 12 months.Results. In total, 140 clinical, demographic, instrumental variables were analysed. There were no statistically significant differences between groups. At baseline, the summary score of the SAQ-7 in the medical group was 63.3 ± 15.7 and in the invasive group was −66.5 ± 13.1 (p = 0.13). The severity of dyspnoea according to the Rose questionnaire in the medical and invasive groups were 1.8 ± 1.1 and 1.9 ± 1.2, respectively, (p = 0.60). By 3 months, the summary score in the invasive group was 89.02 ± 9.2 and was statistically significantly higher than in the medical group (72.3 ± 12.4, p = 0.0001). The subscales of SAQ-7 at 3 months were also statistically significantly higher in the invasive group (p = 0.0001). This statistically and clinically significant difference between the groups persisted up to 12 months. The rate of adverse cardiovascular events was comparable in the study groups to 12 months of follow-up: 12.8% (9/70) and 7.1% (5/70) in the medical and invasive strategies, respectively. The crossover rate (from the medical to the invasive group) was 11.4% (8/70).Conclusion. Our study showed that an invasive strategy should be considered as effective and safe in improving the QoL in symptomatic patients with single-vessel CTO. Received 13 May 2020. Revised 29 May 2020. Accepted 1 June 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributions Conception and design: A.G. Badoian, O.V. Krestyaninov Data collection and analysis: A.G. Badoian, D.A. Khelimskii, O.V. Krestyaninov Statistical analysis: A.G. Badoian, D.A. Khelimskii, R.A. Naydenov Drafting the article: A.G. Badoian, R.U. Ibragimov, D.A. Khelimskii Critical revision of the article: R.U. Ibragimov, O.V. Krestyaninov, R.A. Naydenov Final approval of the version to be published: A.G. Badoian, D.A. Khelimskii, O.V. Krestyaninov, R.U. Ibragimov, R.A. Naydenov
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Badoyan et al. (2020) conducted an RCT in symptomatic patients with single-vessel coronary chronic total occlusion (CTO) (n=140). Invasive strategy (CTO recanalisation) vs. Medical strategy was evaluated on Seattle Quality of Life Questionnaire (SAQ-7) summary score at 3 months (p=0.0001). An invasive strategy significantly improved quality of life compared to medical therapy at 3 months (SAQ-7 score 89.02 vs 72.3, p=0.0001) in symptomatic patients with single-vessel CTO.
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