CTO PCI significantly improves Angina symptoms and QoL without affecting MACE

A groundbreaking study from Iran has brought fresh perspectives to the field of chronic total occlusion (CTO) interventions, where most of the existing evidence originates from Western and Japanese studies. This research not only evaluated the technical success rates and clinical outcomes of an Iranian population undergoing CTO percutaneous coronary intervention (PCI) but also scrutinized the effectiveness of a CTO teaching program, offering valuable insights for the medical community.

The study results were published in the journal Indian Heart Journal. 

Historically, most of the data and insights concerning CTO interventions have been drawn from Western and Japanese studies. However, until now, there has been a scarcity of information emerging from the Middle East, leaving a significant knowledge gap in the understanding of this complex medical procedure. The primary objective of the study was to assess the technical success rates and clinical outcomes of CTO PCI procedures performed in an Iranian population. This research was carried out within a tertiary referral hospital, where operators had varying annual volumes of CTO PCI cases. The study's secondary goal was to evaluate the effectiveness of a dedicated CTO teaching program, which could potentially enhance the success of these complex interventions.

This retrospective, single-center cohort study involved 790 patients who underwent CTO PCI. The procedures were performed by operators with varying annual volumes of CTO PCI cases. Based on the PCI outcomes, the patients were categorized into two groups: those with successful CTO PCI (555 patients, 70.3%) and those with unsuccessful procedures (235 patients, 29.7%). The study's endpoints included Major Adverse Cardiovascular Events (MACE) and the enhancement of health status, assessed using the Seattle Angina Questionnaire, over the course of one year.

Findings: 

• The study revealed an overall success rate of 70% for antegrade and 80% for retrograde approaches, despite the absence of certain CTO-dedicated devices.
• Over the enrollment period, operators with lower annual CTO procedure volumes saw a significant increase in their success rates.
• The one-year MACE rate exhibited similarity between the successful and unsuccessful groups (13.5% in the successful group and 10.6% in the unsuccessful group, p = 0.173).
• Notably, one year after the procedures, patients' health status exhibited significant improvement only within the successful group.

The study findings indicated that there were no notable differences in in-hospital and one-year MACE rates between the successful and unsuccessful CTO PCI groups. However, the successful CTO PCI procedures led to considerable enhancements in angina symptoms and patients' overall quality of life. The RAIAN registry underlines the pivotal role of operator expertise in achieving success in CTO PCI procedures, shedding light on the importance of training programs and experience in enhancing patient outcomes in this field.

Further reading: Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry. DOI: https://doi.org/10.1016/j.ihj.2023.10.002

Indian Heart J. 2023 Oct 20 [Online ahead of print]