Author + information
- Adam Christopher Salisbury,
- John Saxon,
- James Sapontis,
- Kensey Gosch,
- William Lombardi,
- Dimitrios Karmpaliotis,
- Jeffrey Moses,
- Mohammed Qintar,
- Ajay Kirtane,
- John Spertus and
- David Cohen
Background: Risk stratification with stress testing is endorsed by the ACC/AHA Appropriate Use Criteria to identify appropriate candidates for CTO PCI. Furthermore, stress testing is used by some clinicians as a gatekeeper prior to referral for CTO PCI, with a lower likelihood of revascularization for patients with lower risk findings. However, the relationship between stress test risk classification and health status outcomes after CTO PCI is not known.
Methods: We studied 464 patients enrolled in the 12-center OPEN CTO registry who underwent successful CTO PCI and had stress testing prior to PCI. Patients were stratified by low/intermediate-risk (LR) vs. high-risk (HR) findings on pre-procedural stress tests. Health status was assessed using the Seattle Angina Questionnaire Angina Frequency (SAQ AF), Quality of Life (SAQ QoL) and Summary scores (SAQ SS). Change between baseline and 12-month health status scores was compared between groups using multivariable linear regression. The correlation between ischemic burden (percent ischemic myocardium) and health status change was assessed using Pearson correlation coefficients.
Results: Stress tests were LR in 336 (72.4%) and HR in 128 (27.6%) patients; SPECT (74%) and PET (15%) were the most commonly utilized modalities. There was no significant association between stress test status and adjusted health status change for SAQ AF (LR vs HR: 22.9 vs 25.8 points, p=0.08), SAQ QoL (LR vs HR: 25.6 vs 24.5 points, p=0.56) or SAQ QoL (LR vs HR: 24.3 vs 24.6 points, p=0.86). Among patients with ischemic burden quantified on stress reports (n=81), we observed no correlation between the proportion of ischemic myocardium and health status change (SAQ AF: -0.08, p=0.46; SAQ QoL: -0.003, p=0.98; SAQ SS: -0.07, p=0.54).
Conclusions: We observed large health status improvements after CTO PCI in both the LR and HR groups, with no significant difference in baseline to 12-month change scores between the two groups and no correlation between ischemic burden and health status change. These findings suggest that symptomatic patients with low/intermediate risk studies are as likely to experience symptomatic benefit from the procedure as those with high risk stress tests.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Chronic Total Occlusion Intervention
Abstract Category: 20. Interventional Cardiology: Coronary Intervention: CTO
Presentation Number: 1282-119
- 2017 American College of Cardiology Foundation