Association of Stress Test Risk Classification With Health Status After Chronic Total Occlusion Angioplasty (from the Outcomes, Patient Health Status and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO] Study).

Stress testing is endorsed by the American College of Cardiology/American Heart Association Appropriate Use Criteria to identify appropriate candidates for Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI). However, the relation between stress test risk classification and health status after CTO PCI is not known. We studied 449 patients in the 12-center OPEN CTO registry who underwent stress testing before successful CTO PCI, comparing outcomes of patients with low-risk (LR) versus intermediate to high-risk (IHR) findings. Health status was assessed using the Seattle Angina Questionnaire Angina Frequency (SAQ AF), Quality of Life (SAQ QoL), and Summary Scores (SAQ SS). Stress tests were LR in 40 (8.9%) and IHR in 409 (91.1%) patients. There were greater improvements on the SAQ AF (LR vs IHR 14.2 ± 2.7 vs 23.3 ± 1.3 points, p <0.001) and SAQ SS (LR vs IHR 20.8 ± 2.3 vs 25.4 ± 1.1 points, p = 0.03) in patients with IHR findings, but there was no difference between groups on the SAQ QoL domain (LR vs IHR 24.8 ± 3.4 vs 27.3 ± 1.6 points, p = 0.42). We observed large health status improvements after CTO PCI in both the LR and IHR groups, with the greatest reduction in angina among those with IHR stress tests. Although patients with higher risk studies may experience greater reduction in angina symptoms, on average, patients with LR stress tests also experienced large improvements in symptoms after CTO PCI, suggesting patients with refractory symptoms should be considered appropriate candidates for CTO PCI regardless of stress test findings.

Salisbury AC ，Sapontis J ，Saxon JT ，Gosch KL ，Lombardi WL ，Karmpaliotis D ，Moses JW ，Qintar M ，Kirtane AJ ，Spertus JA ，Cohen DJ ，Grantham JA ... -  《-》

Quality of Life Changes After Chronic Total Occlusion Angioplasty in Patients With Baseline Refractory Angina.

Hirai T ，Grantham JA ，Sapontis J ，Cohen DJ ，Marso SP ，Lombardi W ，Karmpaliotis D ，Moses J ，Nicholson WJ ，Pershad A ，Wyman RM ，Spaedy A ，Cook S ，Doshi P ，Federici R ，Nugent K ，Gosch KL ，Spertus JA ，Salisbury AC ... -  《-》

Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry.

Saxon JT ，Grantham JA ，Salisbury AC ，Sapontis J ，Lombardi WL ，Karmpaliotis D ，Moses J ，Nicholson WJ ，Tang Y ，Cohen DJ ，Spertus JA ，Safley DM ... -  《-》

Impact of subintimal plaque modification procedures on health status after unsuccessful chronic total occlusion angioplasty.

We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI. Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI. We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression. SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4-19.7, P = 0.02) greater SAQ SS improvement through 30 days. SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM.

Hirai T ，Grantham JA ，Sapontis J ，Cohen DJ ，Marso SP ，Lombardi W ，Karmpaliotis D ，Moses J ，Nicholson WJ ，Pershad A ，Wyman RM ，Spaedy A ，Cook S ，Doshi P ，Federici R ，Nugent K ，Gosch KL ，Spertus JA ，Salisbury AC ，OPEN CTO Study Group ... -  《-》

Physical Activity After Percutaneous Coronary Intervention for Chronic Total Occlusion and Its Association With Health Status.

Peri-Okonny PA ，Spertus JA ，Grantham JA ，Gosch K ，Kirtane A ，Sapontis J ，Lombardi W ，Karmpaliotis D ，Moses J ，Nicholson W ，Salisbury AC ... -  《Journal of the American Heart Association》