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Background: Health status and quality of life improvement after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) among patients with refractory angina has not been reported. We sought to determine the degree of quality of life improvement after CTO PCI in patients with refractory angina., Methods and Results: Among 1000 consecutive patients who underwent CTO PCI in a 12-center registry, refractory angina was defined as any angina (baseline Seattle Angina Questionnaire [SAQ] Angina Frequency score of ≤90) despite treatment with ≥3 antianginal medications. Health status at baseline and 1-year follow-up was quantified using the SAQ. Refractory angina was present at baseline in 148 patients (14.8%). Technical success was achieved in 120 (81.1%) at the initial attempt and major adverse cardiac and cerebral events occurred in 10 (6.8%). There were no procedural deaths. Refractory angina patients were highly symptomatic at baseline with mean SAQ Angina Frequency of 51.1±23.8, SAQ quality of life of 35.3±21.2, and SAQ Summary Score of 47.2±17.9, improving by 32.0±27.8, 35.7±23.9, and 32.1±20.1 at 1 year. Through 1-year follow-up, patients with successful CTO PCI had significantly larger degree of improvement of SAQ Angina Frequency and SAQ Summary Score (35.0±26.8 versus 18.8±28.9, P<0.01; 34.2±19.4 versus 22.5±20.8, P<0.01) compared with unsuccessful CTO PCI., Conclusions: Refractory angina was present in 1 of 7 patients in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry. Patients with refractory angina experienced large, clinically significant health status improvements that persisted through 12 months, and patients with successful CTO PCI had larger health status improvement than those without.

Aims: The aim of this study was to report the association between episodes of anger and acute myocardial infarction (MI) in patients with angiographically confirmed coronary occlusion., Methods and Results: 313 participants with acute coronary occlusion (Thrombolysis In Myocardial Infarction 0 or 1 at emergency angiography) reported frequency of anger episodes in the 48 h prior to MI. In primary analysis, anger exposures within 2 h and 2-4 h prior to symptom onset were compared with subjects' own usual yearly exposure to anger using case-crossover methodology. Anger level ≥5 (on an anger scale of 1-7) was reported by seven (2.2%) participants within 2 h of MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 h of anger level ≥5 (defined as very angry) was 8.5 (95% confidence interval 4.1-17.6). Anger level <5 was not associated with onset of MI symptoms. Compared with 24-26 h pre MI, anxiety scores >75th percentile on State-Trait Personality Inventory were associated with a relative risk of 2.0 (95% confidence interval 1.1-3.8) and in those above the 90th percentile, the relative risk of MI symptom onset was 9.5 (95% confidence interval 2.2-40.8)., Conclusion: Findings confirm that episodes of intense anger, defined as being 'very angry, body tense, clenching fists or teeth' (within 2 h) are associated with increased relative risk for acute coronary occlusion. Additionally, increased anxiety was associated with coronary occlusion. Further study, including the role of potential modifiers, may provide insight into prevention of MI during acute emotional episodes., (© The European Society of Cardiology 2015.)

Objectives: We aimed to compare quality of life benefits of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) with non-CTO PCI., Background: Data quantifying the benefits of PCI of CTO are inconsistent., Methods: We leveraged a 10-center prospective PCI registry including Seattle Angina Questionnaire (SAQ) assessment at the time of PCI and in follow-up. We propensity matched attempted CTO PCIs with up to 10 non-CTO PCIs. The primary analysis compared changes between baseline and 6 months in SAQ Physical Limitation (PL), Quality of Life (QoL); Angina Frequency (AF) scores as well as the Rose Dyspnea scores (RDS) and the EQ5D Visual Analogue Scale (VAS). Noninferiority was assessed for quality of life changes between CTO and non-CTO PCI., Results: In 3,303 patients enrolled, 167 single-vessel CTOs were attempted; 147 (88%) were matched with 1,616 non-CTO PCI. Baseline PL (73.0 vs. 77.4, P = 0.039) and VAS (66.4 vs. 70.8, P = 0.005) scores were lower for CTO. There was no difference in AF, QoL, or RDS scores. At 6-month follow-up, all SAQ scores improved (P < 0.05 vs. baseline for all) and were equivalent for CTO and Non-CTO (P = NS for all). VAS scores remained lower for CTO, but improved in both groups (P < 0.05 vs. baseline for both). Formal noninferiority testing demonstrated that CTO PCI was not inferior to non-CTO PCI (P ≤ 0.02 for all)., Conclusions: Symptoms, function, QoL, and dyspnea improve to the same degree following CTO PCI as compared with non-CTO PCI. Symptom relief supports CTO PCI to improve patients' quality of life., (© 2013 Wiley Periodicals, Inc.)

Aims: Our objective was to evaluate the relationship between coronary chronic total occlusion (CTO) treatment strategy and quality of life improvements., Methods and Results: This multicentre prospective cohort study enrolled consecutive CTO patients undergoing a non-urgent coronary angiogram who completed the Seattle Angina Questionnaire (SAQ) and EQ-5D at baseline and at one year. Strategies were: i) medical therapy, ii) PCI to non-CTO, iii) PCI to CTO, and iv) CABG. Multivariable regression models compared quality of life changes over time among strategies, accounting for repeat measures per patient. In our cohort of 387 patients, 154 underwent medical therapy, 83 had PCI to the non-CTO artery, 104 underwent CABG, and 46 underwent PCI to the CTO. Medically treated patients had no improvement on any SAQ domains. Patients with revascularisation of the CTO territory with either PCI or CABG had significant improvements in the physical limitation (PCI to CTO 60.5-76.4; CABG 61.6-80.1; p<0.001), angina frequency (PCI to CTO 79.0-92.7; CABG 82.1-97.9; p<0.001), and disease perception (PCI to CTO 50.5-75.0; CABG 50.2-80.0; p<0.001) domains. In non-CTO PCI patients, improvement was restricted to the angina frequency (82.8-93.3; p<0.001), and disease perception (53.8-71.4; p<0.001) domains., Conclusions: CTO territory revascularisation was associated with quality of life improvements.

Background: Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors., Methods: Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed. Participants were categorized as being at low/moderate or high risk for severe coronary obstruction based on results of their nuclear imaging studies. Hierarchical logistic regression models were tested separately for blacks and whites. The first step of the models included clinical factors. The second step included the psychosocial variables of optimism, religiosity, negative affect, and social support. The final step included perceived discrimination., Results: Perceived discrimination was positively related to risk of severe obstruction among blacks but not among whites after controlling for clinical and psychosocial variables. Similar results were found in patients who underwent coronary angiography (n = 311)., Conclusions: Perceived discrimination was associated with risk of severe coronary obstruction among black male veterans and could be an important target for future interventions., (Copyright © 2012 Mosby, Inc. All rights reserved.)