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Title: | Anti-anginal medication titration among patients with residual angina 6-months after chronic total occlusion percutaneous coronary intervention: Insights from OPEN CTO registry. | Authors: | Spertus J.A.;Nicholson W.J.;Grantham J.A.;Salisbury A.C.;Sheehy J.P.;Qintar M.;Arnold S.V.;Hirai T.;Sapontis J.;Jones P.G.;Tang Y.;Lombardi W.;Karmpaliotis D.;Moses J.W.;Patterson C.;Cohen D.J.;Amin A.P. | Institution: | (Sheehy, Qintar, Arnold, Jones, Patterson, Cohen, Spertus, Grantham, Salisbury) Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, United States (Arnold, Jones, Tang, Patterson, Cohen, Spertus, Grantham, Salisbury) Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, United States (Hirai) Section of Cardiology, University of Chicago Medical Center, 924 East 57th Street, Chicago, IL, United States (Sapontis) Monash Heart, Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, Australia (Lombardi) Division of Cardiology, University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, United States (Karmpaliotis, Moses) Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, United States (Amin) Division of Cardiology, Washington University in Saint Louis, 660 S Euclid Ave, St. Louis, MO, United States (Nicholson) Division of Cardiology, York Hospital, 1001 S George St, York, PA, United States | Issue Date: | 31-Oct-2019 | Copyright year: | 2019 | Publisher: | Oxford University Press | Place of publication: | United Kingdom | Publication information: | European Heart Journal - Quality of Care and Clinical Outcomes. 5 (4) (pp 370-379), 2019. Date of Publication: 01 Oct 2019. | Abstract: | Aims: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been shown to reduce angina and improve quality of life, but the frequency of new or residual angina after CTO PCI and its relationship with titration of anti-anginal medications (AAMs) has not been described. Methods and Results: Among consecutive CTO PCI patients treated at 12 US centres in the OPEN CTO registry, angina was assessed 6 months after the index PCI using the Seattle Angina Questionnaire (SAQ) Angina Frequency scale (a score <100 defined new or residual angina). We then compared the proportion of patients with AAM escalation (defined as an increase in the number or dosage of AAMs between discharge and follow-up) between those with and without 6-month angina. Of 901 patients who underwent CTO PCI, 197 (21.9%) reported angina at 6-months, of whom 80 (40.6%) had de-escalation, 66 (33.5%) had no change, and only 51 (25.9%) had escalation of their AAM by the 6-month follow-up. Rates of AAM escalation were similar when stratifying patients by the ultimate success of the CTO PCI, completeness of physiologic revascularization, presence or absence of angina at baseline, history of heart failure, and by degree of symptomatic improvement after CTO PCI. Conclusion(s): One in five patients reported angina 6 months after CTO PCI. Although patients with new or residual angina were more likely to have escalation of AAMs in follow-up compared with those without residual symptoms, only one in four patients with residual angina had escalation of AAMs. Although it is unclear whether this finding reflects maximal tolerated therapy at baseline or therapeutic inertia, these findings suggest an important potential opportunity to further improve symptom control in patients with complex stable ischaemic heart disease.Copyright © 2019 Published on behalf of the European Society of Cardiology. All rights reserved. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1093/ehjqcco/qcz015 | PubMed URL: | 30895291 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30895291] | ISSN: | 2058-5225 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35792 | Type: | Article | Subjects: | priority journal aged *angina pectoris/co [Complication] *angina pectoris/dt [Drug Therapy] article *chronic total occlusion/su [Surgery] *chronic total occlusion/th [Therapy] controlled study disease assessment disease registry drug dose escalation drug dose titration female follow up health status heart failure heart muscle revascularization hospital discharge human major clinical study male medical history *percutaneous coronary intervention scoring system treatment outcome *antiangina pectoris agent/dt [Drug Therapy] Angina Frequency scale score Seattle Angina Questionnaire score female follow up health status heart failure heart muscle revascularization hospital discharge human major clinical study male medical history *percutaneous coronary intervention *chronic total occlusion / *surgery / *therapy scoring system treatment outcome Article *angina pectoris / *complication / *drug therapy aged priority journal controlled study disease assessment disease registry drug dose escalation drug dose titration |
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