EuroPCR 2017: EuroCTO trial: better quality of life for patients with CTO PCI compared with OMT

Reported from EuroPCR 2017, Paris

Randomized data in the field of CTO PCI have been scarce, and conclusive evidence to inform clinical practice seems to still be lacking. Recently, the EXPLORE randomized study showed no difference in effect of CTO PCI vs. medical therapy alone on LV function, in primary PCI-treated STEMI patients with a non-culprit CTO, albeit there was a signal towards more improvement in LV function in a subgroup of patients undergoing PCI for CTO LAD. The DECISION CTO trial also failed to demonstrate benefit of CTO PCI over optimal medical therapy (OMT).

EuroCTO study randomized 396 patients, to either CTO PCI (n=259) or OMT (n=137). Patients undergoing CTO PCI had better Quality of Life, as assessed by the standardized Seattle Angina Questionnaire, characterized by less frequent angina and improved physical activity. Importantly, revascularization was successful in 86.3% of patients, and the rate of cross-over to PCI in the OMT group, due to ongoing angina, was 7.3%. In case of the failure of the first CTO PCI, a second attempt was encouraged.

Due to slow recruitment rates, the study ultimately enrolled a smaller patient population than originally planned (600 patients for the primary efficacy endpoint of Quality of Life and 1200 patients for the primary safety endpoint of death/MI). Nevertheless, the obtained results, indicating improved Quality of Life in patients undergoing CTO PCI, coupled with a low rate of periprocedural complications (1.5% pericardial tamponade and no deaths), may inform the clinical decision-making process when considering CTO PCI.

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