DECISION-CTO: the jury is still out

A trial from South Korea was stopped prematurely due to slow recruitment, leaving unsolved the important clinical question under investigation.

Reported from the American College of Cardiology 2017 Scientific Sessions in Washington.

DECISION-CTO randomized patients with at least one CTO lesion to PCI coupled with optimal medical therapy versus optimal medical therapy alone. Conceptually, the rationale for this study resembles that of the landmark COURAGE trial but now dealing with the most complex lesions in PCI practice. In DECISION-CTO the percentage of CTO PCI success was 91%, and the retrograde approach was used in 24%. The study failed to show significant differences in major adverse cardiac events at 3 years between the study groups (again, a COURAGE-like result), and none of the secondary outcomes of interest, including angina reduction according to the Seattle Angina Questionnaire, was superior in the interventional group. Therefore we are left with a negative yet underpowered study on a very important subject, which anyway will surely inform future meta-analyses when other similar studies will be available.

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