Scores for Chronic Total Occlusion Percutaneous Coronary Intervention: A Window to the Future?

Symptom relief is currently the main indication for CTO PCI.2,5 Several observational studies and 36– 8 of 49 randomizedcontrolled trials showed symptom improvement with CTO PCI compared with optimal medical therapy (OMT) alone. In the EuroCTO (randomized multicenter trial to compare revascularization with OMT for the treatment of chronic total coronary occlusions) trial, 396 patients were randomized to OMT versus OMT+PCI. At 12 months, patients who underwent CTO PCI had greater improvements in angina frequency, quality of life, and physical limitation, as assessed by Seattle Angina Questionnaire.3 In the ImpactorCTO (Impact on Inducible Myocardial Ischemia of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients With Right Coronary Artery Chronic Total Occlusion) trial, 94 patients with angina and isolated dominant right coronary artery CTOs were randomized to OMT versus OMT+PCI. At 12 months, the CTO PCI group had significantly lower myocardial ischemia burden, improved 6minute walk distance, and improved health, as assessed by the 36Item Short Form Survey.4 In the COMETCTO (Randomized Controlled Comparison of Optimal Medical Therapy With Percutaneous Recanalization of Chronic Total Occlusion) trial, 100 patients were randomized to OMT versus OMT+PCI; at 9month followup, patients who underwent CTO PCI had significantly improved physical limitation, angina, treatment satisfaction,