관상 동맥 만성 완전 폐쇄 병변에 대한 관상동맥 중재시술이 건강과 관련된 삶의 질에 미치는 영향에 대한 DECISION-CTO 사후 분석 연구

Abstract

BACKGROUND The Drug-Eluting stent implantation versus optimal medical treatment in patients with ChronIc Total OccluSION (DECISION-CTO) trial showed no significant difference in the quality of life (QoL) measures between the CTO-PCI and no CTO-PCI strategy. Because the study patients were not restricted to those who had isolated CTO disease, PCI for non-CTO lesions may have considerably influenced this result. METHOD We performed a QoL analysis to assess the effect of CTO-PCI by stratifying patients who were enrolled in the trial into isolated CTO disease group and multivessel coronary artery disease (CAD) accompanied by CTO group. Health status was assessed at baseline and 1, 6, 12, 24, and 36 months with the Seattle Angina Questionnaire (SAQ) and visual analogue scale of European Quality of life-5 Dimensions (EQ-5D) score. In SAQ subscales, a change of more than 8 points on physical limitation, 20 points on the angina frequency, and 16 points on the quality of life was considered clinically meaningful improvement. RESULTS A total of 214 patients with isolated CTO disease (111 in the CTO-PCI group, 103 in the no CTO-PCI group) and 590 patients with multivessel CAD (302 in the CTO-PCI group, 288 in the no CTO-PCI group) were included in the analysis. At 1 month, the scores on all domains of the QoL questionnaire had generally increased to a larger extent from baseline in the CTO-PCI arm than in the no CTO-PCI arm in the isolated CTO group, but not in the multivessel CAD group. The improvements in scores were largely maintained by 12 and 36 months. In the between-group analysis for the isolated CTO group, the CTO-PCI strategy had higher mean scores on the SAQ subscales for physical limitation, angina frequency, and QoL than the no CTO-PCI strategy in the early post-PCI period. However, these differences were no longer apparent at later time points. In isolated CTO group, the proportion of patients with clinically meaningful increases in these SAQ domain scores was greater among those treated with CTO-PCI than those without CTO-PCI, particularly at 1 and 6 months. CONCLUSIONS CTO-PCI effectively relieved symptoms and improved quality of life at the early post PCI period in patients with isolated CTO.