Quality of life benefits of percutaneous coronary intervention for chronic occlusions.

OBJECTIVES: We aimed to compare quality of life benefits of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) with non-CTO PCI. BACKGROUND: Data quantifying the benefits of PCI of CTO are inconsistent. METHODS: We leveraged a 10-center prospective PCI registry including Seattle Angina Questionnaire (SAQ) assessment at the time of PCI and in follow-up. We propensity matched attempted CTO PCIs with up to 10 non-CTO PCIs. The primary analysis compared changes between baseline and 6 months in SAQ Physical Limitation (PL), Quality of Life (QoL); Angina Frequency (AF) scores as well as the Rose Dyspnea scores (RDS) and the EQ5D Visual Analogue Scale (VAS). Noninferiority was assessed for quality of life changes between CTO and non-CTO PCI. RESULTS: In 3,303 patients enrolled, 167 single-vessel CTOs were attempted; 147 (88%) were matched with 1,616 non-CTO PCI. Baseline PL (73.0 vs. 77.4, P = 0.039) and VAS (66.4 vs. 70.8, P = 0.005) scores were lower for CTO. There was no difference in AF, QoL, or RDS scores. At 6-month follow-up, all SAQ scores improved (P < 0.05 vs. baseline for all) and were equivalent for CTO and Non-CTO (P = NS for all). VAS scores remained lower for CTO, but improved in both groups (P < 0.05 vs. baseline for both). Formal noninferiority testing demonstrated that CTO PCI was not inferior to non-CTO PCI (P ≤ 0.02 for all). CONCLUSIONS: Symptoms, function, QoL, and dyspnea improve to the same degree following CTO PCI as compared with non-CTO PCI. Symptom relief supports CTO PCI to improve patients' quality of life.

Percutaneous Hemodynamic Support in PCI.

OPINION STATEMENT: Percutaneous coronary intervention (PCI) procedures are attempted with increasingly frequency in hemodynamically unstable, high-risk, and complex patients. Hemodynamic support can be advantageous in select patients presenting with acute myocardial infarction and cardiogenic shock. The need for hemodynamic support has recently shifted from patients with hemodynamic collapse to support of patients during high-risk complex PCI procedures during elective cases such as left main disease, multivessel disease, or low-flow heart failure. Currently, the three most common types of percutaneous hemodynamic support devices available in the United States are the intra-aortic balloon pump (IABP) and the left ventricular assist devices TandemHeart and Impella. Each of these devices has its advantages and disadvantages, and an understanding of the role each plays in various pathophysiologic conditions is necessary, as this will assist the practitioner in making the correct decision as to which device will optimize patient outcomes. Recent studies have called into question the need for certain devices in specific situations. However, ongoing clinical trials will provide further insight into the comparative advantages and disadvantages of each and whether one or more is beneficial over another in reducing cardiovascular events and mortality. With continued refinements in device technology, technique, and application, it is anticipated that percutaneous device-based procedures will continue to improve patient outcomes in the most critically ill and highest-risk patients.