Author + information
- Received February 15, 2018
- Revision received July 2, 2018
- Accepted July 24, 2018
- Published online November 19, 2018.
- Yevgeniy Khariton, MDa,
- Sophia Airhart, MDb,
- Adam C. Salisbury, MD, MSca,
- John A. Spertus, MD, MPHa,
- Kensey L. Gosch, MSa,
- J. Aaron Grantham, MDa,
- Dimitrios Karmpaliotis, MDc,
- Jeffrey W. Moses, MDc,
- William J. Nicholson, MDd,
- David J. Cohen, MD, MSca,
- William Lombardi, MDe,
- James Sapontis, MDf and
- James M. McCabe, MDe,∗ ()
- aSaint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
- bUniversity of Arizona Medical Center, Tucson, Arizona
- cColumbia University Medical Center, New York Presbyterian Hospital, New York, New York
- dYork Hospital, York, Pennsylvania
- eUniversity of Washington, Seattle, Washington
- fThe Avenue Hospital and Monash Medical Center, Windsor, Victoria, Australia
- ↵∗Address for correspondence:
Dr. James M. McCabe, University of Washington, Seattle, 1959 NE Pacific Street, Box 356422, Seattle, Washington.
Objectives This study sought to describe the association between chronic total occlusion (CTO) revascularization (CTO percutaneous coronary intervention [PCI]) and health status in patients with and without cardiomyopathy.
Background Prior PCI trials for cardiomyopathy have excluded CTO patients. Whether patients with reduced left ventricular ejection fraction (LVEF) receive similar health status benefit from CTO-PCI compared with patients with normal LVEF is unclear.
Methods We assessed health status change, using the Seattle Angina Questionnaire (SAQ) Summary, SAQ Angina Frequency, and Rose Dyspnea Scale scores, among patients undergoing successful CTO PCI in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) Registry. Participants were classified by LVEF (normal, ≥50%; mild-moderate, 30% to 49%; and severe, <30%), with higher SAQ and lower Rose Dyspnea Scale scores indicating better health status. Differences in 1-year outcomes were compared using hierarchical multivariable regression.
Results Of 762 patients, 506 (66.4%), 193 (25.3%), and 63 (8.3%) had normal, mild-moderate, and severely reduced LVEF. SAQ Summary score improvements were observed in each group (27.1 ± 20.4, 26.7 ± 21.2, and 20.3 ± 18.1, respectively). Compared with patients with LVEF ≥50%, those with LVEF <30% had less improvement in SAQ Summary Score (−5.2 points; 95% confidence interval: −9.0 to −1.5; p = 0.01) and Rose Dyspnea Scale (+0.5 points; 95% confidence interval: 0.1 to 0.8; p = 0.01), with no difference in odds of angina (odds ratio: 1.3; 95% confidence interval: 0.6 to 3.0; p = 0.48). Health status improvement was similar between patients with LVEF ≥50% and LVEF 30% to 49%.
Conclusions Although health status improvement was less in patients with severely reduced LVEF compared with those with normal LVEF, each group experienced large health status improvements after CTO-PCI.
Funded by Saint Luke’s Hospital of Kansas City, with Investigator Initiated Research Grant from Boston Scientific Corporation. Dr. Khariton is supported by the National Heart, Lung, and Blood Institutes of Health under Aware Number T32HL110837; the content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. Dr. Salisbury has received institutional grant support from Boston Scientific and Gilead; speaking fees and honoraria from Boston Scientific and Abiomed; and consulting fees from Medtronic. Dr. Spertus has received research grants from Lilly, Gilead, and Abbott Vascular; served as a consultant for Novartis, Amgen, Regeneron, and United Healthcare; owns the copyright to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire and Peripheral Artery Questionnaire; and has an equity interest in Health Outcomes Sciences. Dr. Grantham has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Asahi Intecc; institutional research grant support from Boston Scientific; institutional educational grant support from Abbott Vascular, Vascular Solutions, Boston Scientific, and Asahi Intecc; and part-time employment by Corindus Vascular Robotics. Dr. Karmpaliotis has received speaking fees, honoraria, and consulting fees from Abbott Vascular, Boston Scientific, and Medtronic. Dr. Nicholson is a consultant and on the Advisory Board for Boston Scientific, Medtronic, and Abbott Vascular. Dr. Cohen has received institutional research grant support from Boston Scientific, Abbott Vascular, and Medtronic; and consulting fees from Medtronic and Abbott Vascular. Dr. Lombardi has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Abiomed; consultancy for Vascular Solutions, Abbott Vascular, Boston Scientific, Abiomed, and Roxwood Medical; has equity in Roxwood Medical and Bridgepoint Medical; and his wife is an employee of Spectranetics. Dr. Sapontis has received speaking fees and honoraria from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 15, 2018.
- Revision received July 2, 2018.
- Accepted July 24, 2018.
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