CTO PCI similar to medical therapy in CV death, MI risk at 3 years: EURO-CTO
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SAN FRANCISCO — At 3 years, among patients with a chronic total coronary occlusion, those who underwent CTO PCI had similar rates of CV death and MI compared with those on optimal medical therapy alone, according to the safety results of the EURO-CTO trial.
Overall major CV events were lower in the CTO PCI group, driven by reduced risk for ischemia-driven revascularization, Gerald S. Werner, MD, PhD, director of the department of cardiology and intensive care at Klinikum Darmstadt, the teaching hospital of the University of Frankfurt, Germany, said during a press conference.
The primary safety endpoint of CV death and MI at 3 years did not differ between those assigned CTO PCI plus optimal medical therapy and those assigned optimal medical therapy alone (CTO PCI, 5%; medical therapy, 2.9%; log-rank P = .32), Werner said.
Major cardiac and cerebrovascular events at 3 years were lower in the CTO PCI group (10.7% vs. 20.1%; log-rank P = .019), mostly due to lower rates of ischemia-driven revascularization (7.3% vs. 18.2%; log-rank P = .0035), he said.
All-cause death at 3 years did not differ between the groups (log-rank P = .14), nor did CV mortality (log-rank P = .42), according to the researchers.
The primary efficacy endpoint, Seattle Angina Questionnaire score at 1 year, was reported in 2017. The CTO PCI group had significantly better scores than the medical therapy group in anginal frequency and quality of life, Werner said.
The researchers randomly assigned 137 patients (mean age, 65 years; 86% men) to optimal medical therapy and 259 patients (mean age, 65 years; 83% men) to CTO PCI plus medical therapy. Werner noted that 16% to 18% of lesions in patients with stable CAD are CTOs. Among patients in the trial with multivessel disease, all non-CTO lesions were treated before randomization, in contrast with patients from the DECISION-CTO trial, he said.
“The longer follow-up showed that PCI for CTO did not lead to a significantly higher rate of cardiovascular events,” Werner said at the press conference. “In addition, we found a reduction in MACE occurred in the PCI group driven by less need for ischemia-driven revascularization.” – by Erik Swain
Reference:
Werner GS, et al. Late-Breaking Science 3. Presented at: TCT Scientific Symposium; Sept. 25-29, 2019; San Francisco.
Disclosure: The study was sponsored by EuroCTO Club e.V., which received unrestricted grants from Asahi and Biosensors. Werner reports no relevant financial disclosures.