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. 2023 Jan 9:9:1014664.
doi: 10.3389/fcvm.2022.1014664. eCollection 2022.

Long-term follow-up of patients with chronic total coronary artery occlusion previously randomized to treatment with optimal drug therapy or percutaneous revascularization of chronic total occlusion (COMET-CTO)

Stefan A Juricic  1 , Sinisa M Stojkovic  1   2 , Alfredo R Galassi  3   4 , Goran R Stankovic  1   2   5 , Dejan N Orlic  1   2 , Vladan D Vukcevic  1   2 , Dejan G Milasinovic  1   2 , Srdjan B Aleksandric  1   2 , Miloje V Tomasevic  1   6 , Milan R Dobric  2   7 , Milan A Nedeljkovic  1   2 , Branko D Beleslin  1   2 , Miodrag P Dikic  1 , Marko D Banovic  1   2 , Miodrag C Ostojic  2   5 , Milorad B Tesic  1   2
Affiliations

Long-term follow-up of patients with chronic total coronary artery occlusion previously randomized to treatment with optimal drug therapy or percutaneous revascularization of chronic total occlusion (COMET-CTO)

Stefan A Juricic et al. Front Cardiovasc Med. .

Abstract

Background: The COMET-CTO trial was a randomized prospective study that assessed long-term follow-up in patients with chronic total occlusion (CTO) in coronary arteries treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT). During the 9-month follow-up, the incidence of major adverse cardiac events (MACE) did not differ between the two groups; no death or myocardial infarction (MI) was observed. There was a significant difference in quality of life (QoL), assessed by the Seattle Angina Questionnaire (SAQ), in favor of the PCI group. Here we report long-term follow-up results (56 ± 12 months).

Methods: Between October 2015 and May 2017, a total of 100 patients with CTO were randomized into two groups of 50 patients: PCI CTO or OMT group. The primary endpoint of the current study was the incidence of MACE defined as cardiac death, MI, and revascularization [PCI or coronary artery bypass graft (CABG)]. As the secondary exploratory outcome, we analyzed all the cause-mortality rate.

Results: Out of 100 randomized patients, 92 were available for long-term follow-up (44 in the PCI group and 48 in the OMT group). The incidence of MACE did not differ significantly between the two groups (p = 0.363). Individual components of MACE were distributed, respectively: cardiac death (OMT vs. PCI group, 6 vs. 3, p = 0.489), MI (OMT vs. PCI group, 1 vs. 0, p = 1), and revascularization (PCI: OMT vs. PCI group, 2 vs. 2, p = 1; CABG: OMT vs. PCI group, 1 vs. 1, p = 1). There was no significant difference between the two groups regarding the individual component of MACE. Six patients died from non-cardiac causes [five deaths were reported in the OMT group and one death in the PCI group (p = 0.206)]. Kaplan-Meier survival curves for MACE did not differ significantly between the study groups (log-rank 0.804, p = 0.370). Regarding the secondary exploratory outcome, a total of 15 patients died at 56 ± 12 months (11 in the OMT and 4 in the PCI group) (p = 0.093). The Kaplan-Meier survival curves for all-cause mortality rates did not differ significantly between the two groups (log rank 3.404, p = 0.065). There were no statistically significant differences between OMT and PCI groups in all five SAQ domains. There was a significant improvement in three SAQ domains in the PCI group: PL (p < 0.001), AF (p = 0.007), and QoL (p = 0.001).

Conclusion: After 56 ± 12 months of follow-up, the incidence of MACE, as well as QoL measured by SAQ, did not differ significantly between the PCI and OMT groups.

Keywords: chronic total occlusion; long-term follow-up; optimal medical therapy; outcomes; percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves for the MACE. PCI, percutaneous coronary intervention; OMT, optimal medical therapy.
FIGURE 2
FIGURE 2
Kaplan–Meier survival curves for all-cause mortality. PCI, percutaneous coronary intervention; OMT, optimal medical therapy.
FIGURE 3
FIGURE 3
SAQ subscale changes. QoL, quality of life; PL, physical limitation; AS, angina stability; AF, angina frequency; TS, treatment satisfaction; PCI, percutaneous coronary intervention; OMT, optimal medical therapy; FUP, follow-up. Δ: difference between f-up and baseline mean values.
See this image and copyright information in PMC

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