Author + information
- Eric Secemsky1,
- J. Aaron Grantham2,
- John Spertus3,
- David Cohen4,
- Philip Jones5,
- Adam Salisbury3,
- Suzanne Arnold4,
- Frank Harrell Jr.6,
- William Lombardi7,
- Dimitrios Karmpaliotis8,
- Jeffrey Moses9,
- James Sapontis10 and
- Robert Yeh11
- 1MGH, Boston, Massachusetts, United States
- 2University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 3Mid America Heart Institute, Kansas City, Missouri, United States
- 4Saint Luke's Mid America Heart Institute, Kansas City, Missouri, United States
- 5St. Luke's Hospital, Mid-America Heart Institute, Kansas City, Missouri, United States
- 6Vanderbilt University, Nashville, Tennessee, United States
- 7University of Washington Medical Center, Seattle, Washington, United States
- 8Interventional Cardiologist, New York, New York, United States
- 9NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 10MonashHeart, Victoria, Victoria, Australia
- 11Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Chronic total occlusion (CTO) PCI is associated with both risks and benefits. Strategies to identify those most likely to improve after CTO PCI are needed.
Using data from OPEN CTO, an adjudicated 12-center registry of consecutive patients undergoing CTO PCI by the hybrid approach, we used pre-PCI variables and ordinal regression to create a risk tool to predict angina-related health status 6 months after CTO PCI, as measured by the Seattle Angina Questionnaire (SAQ) summary score. Internal validation was performed using bootstrap methodology.
Of 901 patients, the mean age was 66±10 years, 81% were male, 40% were diabetic and 76% had prior revascularization. The median SAQ summary score at baseline was 62 (IQR 45-81) and post-CTO PCI was 94 (IQR 83-100). Predictors of better health status after CTO PCI included higher baseline SAQ scores, lower baseline Personal Health Questionnaire Depression Scale (PHQ-8) scores, no prior coronary revascularization, higher LVEF, no history of avoiding care due to costs, single CTO lesion and PCI performed for a reason other than symptom/ischemia reduction. A point score system corresponding with 6-month SAQ summary scores was developed, where higher scores are better (Figure). The model had a R2 of 0.24 and a Spearman’s rho correlation between predicted and observed scores of 0.44, with a R2 of 0.20 after bootstrap validation.
This novel risk tool involving 7 pre-PCI variables can be used to predict patients’ 6-month angina-related health status after CTO PCI. Such a tool can be used to support patient selection and shared decision making.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)