Effects of Depression on Angina Severity in Patients Undergoing Chronic Total Occlusion PCI

comforting patient, depression
Depression is common in patients with chronic total occlusion, and has been linked to more severe baseline angina.

Depression is common among patients with chronic total occlusion (CTO) and is linked to more severe baseline angina, according to study results published in JACC Cardiovascular Interventions.

However, the results also indicated that patients with CTO with depression experience significant health improvements after percutaneous coronary intervention (PCI).

The study included participants with CTO from the Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures (OPEN-CTO) registry who underwent PCI (n=811).

The researchers evaluated change in health status between baseline and 1-year post-PCI by using the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. They defined depression using the Personal Health Questionnaire. The researchers used multivariable regression to assess the association between health status and depression after PCI.

Of the 811 participants, 23% (n=190) screened positively for major depression. Of these, 6.3% were receiving antidepressants at baseline.

The results indicated that at baseline, participants with depression had more angina. However, at 1 year post-PCI, these participants had greater improvements (change in SAQ, 31.4±22.4) compared with those without depression (change in SAQ, 24.2±20.0; P<.001).

After adjusting for potential confounders, the researchers found that participants with depression at baseline had a greater improvement in health status compared with participants without depression (adjusted difference in SAQ-Summary improvement, depressed vs nondepressed, 5.48±1.81; P=.003).

“This study may indicate that CTO patients should be a target for more concerted depression screening and treatment alongside interventional treatment in an effort to optimize their care and help them achieve greater symptom benefit,” the researchers wrote.

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Disclosures: The study was an investigator-initiated registry funded by Boston Scientific. Multiple study authors have disclosed relationships with the pharmaceutical industry. Please refer to reference for full list of author disclosures.


Yeh RW, Tamez H, Secemsky EA, et al. Depression and angina among patients undergoing chronic total occlusion percutaneous coronary intervention: the OPEN-CTO registry [published online March 9, 2019]. JACC Cardiovasc Interv. doi: 10.1016/j.jcin.2018.12.029