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February 11, 2020

OPEN-CTO Registry Used to Evaluate Appropriate Use Criteria and Outcomes After Chronic Total Occlusion PCI

February 11, 2020—In Circulation: Cardiovascular Interventions, John T. Saxon, MD, et al evaluated appropriate use criteria (AUC) and health status outcomes from the OPEN-CTO registry.

According to the investigators, the background of this analysis is that the American College of Cardiology/American Heart Association AUC were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown.

As summarized in Circulation: Cardiovascular Interventions, the investigators analyzed 769 patients with baseline and 1-year health status data after CTO PCI. Procedures were categorized as “appropriate,” “may be appropriate,” or “rarely appropriate.”

Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across AUC categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤ 10 points), intermediate (10–19 points), large (20–29 points), and very large (≥ 30 points).

The investigators reported that the AUC indication was appropriate in 573 patients (74.5%), may be appropriate in 191 patients (24.8%), and rarely appropriate in five patients (0.7%).

Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3 ± 21.3 points) at 1 year compared with patients in the may be appropriate group (22.5 ± 20.9; P = .01). A similar pattern was noted for SAQ angina frequency (mean change 24 ± 27.2 vs 18.7 ± 25.6; P = .02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% vs 33.3%; P = .01).

The investigators concluded that among patients undergoing CTO PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well, stated the investigators in Circulation: Cardiovascular Interventions.

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