Comparison of the effects of percutaneous coronary intervention and medical treatment on quality of life in patients with chronic total occlusion
E Yalcin, M Aydogan, S Emet, A ElitokAbstract
Aim
Resistant angina despite optimal medical treatment (OMT) is a common condition in patients with chronic coronary syndrome (CCS) that reduces their quality of life. In these patients, the presence of chronic total occlusion (CTO) is a strong predictor of incomplete revascularization. A better understanding of the burden of angina in these patients and the improvement in quality of life after percutaneous coronary intervention (PCI) is critical in determining treatment management. This study aimed to investigate the relationship between successful CTO-PCI and health status variability in patients with angina or equivalent symptoms.
Materials and Methods
Between 2020 and 2025, 109 patients who presented to our clinic with a diagnosis of CCS and were found to have CTO were included in the study. Patients were divided into two groups: those who underwent successful PCI and those who only received OMT. Patients were evaluated at baseline and 12 months later using the "Seattle Angina Questionnaire," "Rose Dyspnea Score," and "Canadian Cardiovascular Society Angina Score."
Results
Demographic data, laboratory variables, and left ventricular ejection fraction (LVEF) were similar among the patients included in the study. Except for a history of cerebrovascular accident (CVA), no statistically significant clinical features were observed. The number of patients with LAD CTO was 7 (13.7%) in the OMT group and 33 (56.9%) in the PCI group, and was statistically significant (p <0.001). The median J-CTO score was 2 (2.0-3.0) in the OMT group and 1 (0.0-2.0) in the PCI group, and was found to be significantly higher in the OMT group (P<0.001). In both the OMT and PCI groups, CCS and RDS scores showed a significant decrease compared to baseline at the end of 12 months (p<0.001). However, when comparing the change in improvement values in CCS and RDS scores, this difference was found to be statistically more pronounced in patients in the PCI group (p=0.001, p=0.029, respectively). When the baseline and 12-month values of the SAQ parameters were analyzed, patients in both groups showed a statistically significant improvement in all five parameters and the summary score compared to baseline values. When comparing the improvement change values of the groups, it was found that this difference was significantly greater in patients in the PCI group compared to the OMT group in all parameters (p<0.001).
Conclusion
Significant improvement was observed in all SAQ parameters, CCS Angina Score, and Rose Dyspnea Score in patients in both groups. However, when the amount of change after one year was examined, the improvement in the PCI group was found to be significantly higher than in the OMT group. To improve the success of CTO interventions, careful patient selection focusing on symptomatic patients and determining the risk category of the lesion are important.SAQ scoreFor image description, please refer to the figure legend and surrounding text.CCS Angina Score and Rose Dyspnea ScoreFor image description, please refer to the figure legend and surrounding text.