Chronic total occlusion occurs in around 20% of patients with stable coronary artery disease but accounts for only 7% of patients undergoing PCI because of a lack of evidence on the benefits compared to optimal medical therapy.
The EURO-CTO trial randomised 396 patients from 26 centres on a 2:1 basis to PCI or optimal medical therapy. Optimal medical therapy comprised standard secondary prevention medications plus anti-anginal drugs, including beta-blockers, nitrates, calcium antagonists and others, primarily ranolazine. Half (50%) of the patients had single vessel CTOs and 30% had a non-CTO lesion treated before randomisation. Nine patients randomised to optimal medical therapy crossed over to PCI during follow-up.
Results showed a high procedural success rate with PCI and low procedural risk. The chronic total occlusion was successfully opened in 86.3% of patients treated with PCI. There were no procedural deaths and the overall 12-month major adverse cardiac and cerebrovascular events (MACCE) rate was 0.4% (3 cases of tamponade, 1 stroke, 2 vascular repair).
Improvement in clinical symptoms was more pronounced in patients treated with PCI than with optimal medical therapy, based on the Seattle Angina Questionnaire (SAQ) subscales of physical limitation and angina frequency. The PCI group also showed a trend to improved quality of life and significantly greater absolute freedom from angina.
"The clinical symptoms and wellbeing of patients with chronic total occlusion improve more efficiently with PCI than with optimal medical therapy. PCI should be the primary treatment option for these patients," said lead author Gerald Werner, Professor of Cardiology and Director of the Cardiology Department at Klinikum Darmstadt, Darmstadt, Germany.
Current guidelines for managing stable coronary artery disease do not accept a CTO as an indication to perform CTO, in contrast to non-occlusive lesions. Werner said, "This study should lead to reconsideration of this assessment. In fact, there is no study that would prove that a CTO lesion is benign compared to a non-CTO lesion, so why should they be treated differently?"
Contact: Gerald Werner, Klinikum Darmstadt, Darmstadt, Germany
EuroPCR 2017 session: Thursday 18 May 9.45-10.45 Hot line/Late-breaking trials, Coronary Interventions, Interventions for Valvular Disease, CTO, STEMI, Stents and scaffolds, TAVI; Main Arena
Help for journalists to cover EuroPCR 2017
For any press-related inquiries, please contact:
EuroPCR Press Coordinator, Isabelle Uzielli email@example.com
Register and attend EuroPCR 2017 as a journalist
Press registration for EuroPCR is open to accredited journalists, free of charge. Journalists must hold a valid press card and/or provide a letter of assignment from a recognised publication. To register as press go to https://www.pcronline.com/Courses/EuroPCR/EuroPCR-2017/Press
EuroPCR press releases
EuroPCR press releases can be found at https://www.pcronline.com/News/Press-releases?date=2017
Attend press briefings
For the press briefing schedule check https://www.pcronline.com/Courses/EuroPCR/EuroPCR-2017/Press
Abstracts are available online at https://www.pcronline.com/Courses/EuroPCR/EuroPCR-2017
Notes to Editors
What is EuroPCR?
EuroPCR, the official annual meeting of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), a registered branch of the European Society of Cardiology, is the world-leading course in interventional cardiovascular medicine. PCR has established a distinctive format for educational activities in the field of cardiovascular interventions. Beyond its flagship course in Paris that gathers more than 11,500 participants every year, PCR organises annual courses in Singapore, London UK, Dubai EAU, Johannesburg RSA, Milan Italy, Chengdu China and Tokyo Japan.
For further information on EuroPCR, PCR London Valves, PCR Peripheral, PCR-CIT China Chengdu Valves, GulfPCR-GIM, AsiaPCR, AfricaPCR, PCR Tokyo Valves, and all PCR activities, please contact: Célia Vilà: firstname.lastname@example.org.
For more information, please visit: https://www.pcronline.com/Courses/EuroPCR/EuroPCR-2017 and follow us on Twitter https://twitter.com/PCRonline using the hashtag #EuroPCR