title: Percutaneous Coronary Intervention of Coronary Chronic Total Occlusions Improves Peak Oxygen Uptake During Cardiopulmonary Exercise Testing.
abstract: OBJECTIVE
  Although coronary chronic total occlusions (CTOs) are treated with percutaneous coronary intervention (PCI) to improve symptoms, studies demonstrating symptom improvement have been mostly limited to questionnaire responses. The current study assessed for changes in peak oxygen uptake during cardiopulmonary exercise testing after CTO-PCI.
  
  
  METHODS
  Patients with heart failure or angina symptoms referred for CTO-PCI were prospectively enrolled. The primary outcome of the study was improvement in peak oxygen uptake during cardiopulmonary exercise (CPX) testing 5 months after CTO-PCI. Secondary outcomes included improvement in physical capacity, angina, and self perception of health as assessed by questionnaires, and in plasma brain natriuretic peptide (BNP) levels.
  
  
  RESULTS
  CTO-PCI was attempted in 32 men (mean age, 62 ± 6 years; CTO vessel: 47% right coronary, 44% left anterior descending). CTO-PCI was unsuccessful in 1 patient, and 3 patients had restenosis of their CTO vessel at follow-up. In the 28 patients with patent CTO vessel at follow-up, significant improvements were noted in self-reported physical capacity, angina, and several aspects of health perception. In the 25 patients who underwent baseline and follow-up CPX testing, peak oxygen uptake significantly improved from 17.7 ± 4.3 mL/kg/min to 19.1 ± 4.0 mL/kg/min (P=.02). Plasma BNP levels significantly decreased from 143 ± 138 pg/mL to 102 ± 123 pg/mL (P=.01).
  
  
  CONCLUSIONS
  CTO-PCI in symptomatic patients was associated with improvements in cardiovascular exercise capacity, as assessed by peak oxygen uptake. These results suggest that in symptomatic patients with CTOs, PCI appears clinically beneficial.
authors.affiliation: Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216 USA. shuaib.abdullah@va.gov.
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Suwetha
authors.initials: S
authors.lastname: Amsavelu
authors.forename: Fransisco
authors.initials: F
authors.lastname: Garcia-Morales
authors.forename: Fury
authors.initials: F
authors.lastname: Hendrix
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.forename: Houman
authors.initials: H
authors.lastname: Khalili
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D059026:Diagnostic Self Evaluation; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D000071066:Patient Reported Outcome Measures; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D010807:Physical Endurance; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States