Key result
A novel 7-variable model demonstrated good discrimination (c-statistic 0.78) for predicting 6-month angina frequency after chronic total occlusion percutaneous coronary intervention.
A patient is referred for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Should CTO PCI be offered?It should, if we knew that the patient would derive benefit and would not be harmed (Figure ).1,2 Unfortunately, we do not always have a window to the future, as the assessment of risks and benefits can be challenging and subjective. RISKSCTO PCI carries increased risk of complications compared with non-CTO PCI, including perforation, periprocedural myocardial infarction, and radiation skin injury.3 The average periprocedural complication risk is ≈3%. 4 The risk increases with increasing angiographic complexity, use of advanced CTO techniques, such as the retrograde approach, older patient age, and comorbidities. BENEFITSSymptom relief is currently the main indication for CTO PCI.2,5 Several observational studies and 3 6-8 of 4 9 randomized-controlled trials showed symptom improvement with CTO PCI compared with optimal medical therapy (OMT) alone.In the EuroCTO (randomized multicenter trial to compare revascularization with OMT for the treatment of chronic total coronary occlusions) trial, 396 patients were randomized to OMT versus OMT+PCI.At 12 months, patients who underwent CTO PCI had greater improvements in angina frequency, quality of life, and physical limitation, as assessed by Seattle Angina Questionnaire. 3 In the Impactor-CTO (Impact on Inducible Myocardial Ischemia of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients With Right Coronary Artery Chronic Total Occlusion) trial, 94 patients with angina and isolated dominant right coronary artery CTOs were randomized to OMT versus OMT+PCI.At 12 months, the CTO PCI group had significantly lower myocardial ischemia burden, improved 6-minute walk distance, and improved health, as assessed by the 36-Item Short Form Survey.4 In the COMET-CTO (Randomized Controlled Comparison of Optimal Medical Therapy With Percutaneous Recanalization of Chronic Total Occlusion) trial, 100 patients were randomized to OMT versus OMT+PCI; at 9-month follow-up, patients who underwent CTO PCI had significantly improved physical limitation, angina, treatment satisfaction, The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
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Simsek et al. (2022) conducted an editorial in Chronic total occlusion (n=901). 7-variable angina prediction model was evaluated on Prediction of angina frequency at 6 months using the Seattle Angina Questionnaire (c-statistic 0.78). A novel 7-variable model demonstrated good discrimination (c-statistic 0.78) for predicting 6-month angina frequency after chronic total occlusion percutaneous coronary intervention.
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