<div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1366419508" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{10}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Single chronic total occlusion (CTO) patients treated with percutaneous coronary intervention (PCI) fared better<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">in quality of life (QoL) and angina endpoints than those on<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">optimal</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>medical therapy (OMT), a new post-hoc analysis</span><span> </span><span class="NormalTextRun SCXW62831797 BCX0">found.<span> </span></span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1216986027" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{12}"><span class="NormalTextRun SCXW62831797 BCX0">The results were published Monday online in the<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">Journal of American College of Cardiology</span><span class="NormalTextRun SCXW62831797 BCX0">, with authors led by<span> </span></span><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Gerald S. Werner, MD, P</span><span class="NormalTextRun SCXW62831797 BCX0">h</span><span class="NormalTextRun SCXW62831797 BCX0">D,</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>from<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">Goethe University,</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>Germany. </span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1301591411" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{14}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">D</span><span class="NormalTextRun SCXW62831797 BCX0">espite a “clear benefit for<span> </span></span></span><a class="Hyperlink SCXW62831797 BCX0" href="https://pubmed.ncbi.nlm.nih.gov/32227753/" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink">clinical symptom relief</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">,</span><span class="NormalTextRun SCXW62831797 BCX0">”</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>the QoL benefit to be gained from</span><span> </span><span class="NormalTextRun SCXW62831797 BCX0">PCI vs OMT</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>used to treat<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">CTOs</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>has been “under debate” because of a scarcity of available randomized clinical trials (RCTs)</span><span class="NormalTextRun SCXW62831797 BCX0">, the researchers said.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1400284869" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{16}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">And while<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">patients with a CTO<span> </span></span></span><a class="Hyperlink SCXW62831797 BCX0" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807447" target="_blank" rel="noreferrer noopener"><span data-contrast="none" xml:lang="EN-GB" lang="EN-GB" class="TextRun Underlined SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink">appear</span><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink"><span> </span>to improve</span></span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>symptomatically after PCI,<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">“</span><span class="NormalTextRun SCXW62831797 BCX0">current<span> </span></span></span><a class="Hyperlink SCXW62831797 BCX0" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001038" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink">guidelines</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>do not recommend revascularization of a CTO for symptom relief</span><span class="NormalTextRun SCXW62831797 BCX0">,” they said, adding that the basis of this decision is the 2 largest RCTs;<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">the</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>European</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>EUROCTO</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>study and Asian<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">DECISION-CTO</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>trial. </span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="501774487" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{18}"><span class="NormalTextRun SCXW62831797 BCX0">While<span> </span></span><a class="Hyperlink SCXW62831797 BCX0" href="https://pubmed.ncbi.nlm.nih.gov/29722796/" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink">EUROCTO</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span> </span><span class="NormalTextRun SCXW62831797 BCX0">showed improved symptom relief and quality of life after PCI as compared with OMT</span><span> </span><span class="NormalTextRun SCXW62831797 BCX0">with antianginal medication</span><span class="NormalTextRun SCXW62831797 BCX0">,<span> </span></span></span><a class="Hyperlink SCXW62831797 BCX0" href="https://pubmed.ncbi.nlm.nih.gov/30813758/" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW62831797 BCX0" data-ccp-charstyle="Hyperlink">DECISION-CTO</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>showed no difference</span><span class="NormalTextRun SCXW62831797 BCX0">, the</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>authors<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">wrote</span><span class="NormalTextRun SCXW62831797 BCX0">.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="2074650143" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{20}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">“</span><span class="NormalTextRun SCXW62831797 BCX0">These discrepancies can be explained by the high rate of non-CTO intervention in DECISION-CTO after randomization, whereas in EUROCTO non-CTO PCI was performed before randomization</span><span class="NormalTextRun SCXW62831797 BCX0">.”</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="92812167" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{22}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">The researchers therefore<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">set out to address the “disparity” of both studies<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">regarding</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>the impact of non-CTO PCI</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>by merging</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>patients in a post</span><span class="NormalTextRun SCXW62831797 BCX0">-</span><span class="NormalTextRun SCXW62831797 BCX0">hoc</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>pooled analysis to create the “cleanest<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">randomized-derived dataset currently available</span><span class="NormalTextRun SCXW62831797 BCX0">.”</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>Their focus was on the benefit of either treatment modality when CTO is the only clinically relevant lesion.<span> </span></span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="232707434" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{24}"><span class="NormalTextRun SCXW62831797 BCX0">A total 518 patients with a single CTO and no other significant coronary lesion were extracted from the 2 trials and randomized 1:1 in DECISION-CTO and 2:1 in EUROCTO. Of the current study’s cohort, 224 received OMT and 294 PCI.</span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1792164303" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{26}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">At baseline, the only significantly different factors between the two treatment groups were history of bypass surgery (occurring in 3.1% of OMT vs 7.5% of PCI; P = 0.03), the rate of r</span><span class="NormalTextRun SCXW62831797 BCX0">eversible ischemia test</span><span class="NormalTextRun SCXW62831797 BCX0">ing (56.7% vs 64.3%, respectively) and the<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">J-CTO procedural difficulty score (a mean of 1.73</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>± 0.74</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>vs 1.87<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">± 0.7</span><span class="NormalTextRun SCXW62831797 BCX0">8, respectively).</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="732949067" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{28}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Overall, patients’ mean age was 62.8 years<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">± 10.1</span><span class="NormalTextRun SCXW62831797 BCX0">, the majority (82.8%) were male, 29.2% were diabetic and left ventricular ejection fraction was a mean of 56.8%<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">±<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">9.8.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="8269096" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{30}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">PCI was successful in 92.2% of cases, and on intention-to-treat analysis, appeared to be superior to OMT for the change of angina frequency scores between baseline and follow-up (12.2 vs 8.6; P = 0.009) and the</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>Seattle Angina Questionnaire (SAQ)</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>summary score (13.8 bs 8.5; P < 0.001), although the researchers noted there was a “wide variability” of changes in SAQ scores. </span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1917991014" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{32}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">PCI was also better for change in QoL score (19.5 vs 11.3; P <0.001), though f</span><span class="NormalTextRun SCXW62831797 BCX0">or physical limitation, the difference was just at the level of the Bonferroni correction for multiple tests (P = 0.01)</span><span class="NormalTextRun SCXW62831797 BCX0">, the researchers stressed.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="906151335" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{34}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">The major factor behind a significant improvement in QoL was a low baseline score and assignment to PCI, the researchers added, noting that gender,<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">diabetes</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>and lesion complexity had no influence.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="734216263" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{36}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">During a mean follow-up of 3.1 years, the clinical endpoints of cardiac death or nonfatal myocardial infarction were similar in both groups<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">(OMT vs PCI: 2.7% vs 5.1%; P = 0.17)</span><span class="NormalTextRun SCXW62831797 BCX0">, as were rates of stroke (5 patients in both groups; P = 0.66) or hospitalization for bleeding. </span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="467099346" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{38}"><span class="NormalTextRun SCXW62831797 BCX0">Only target lesion revascularizations were more frequent with OMT (18.8% vs 10.6%; P = 0.005).</span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="596453088" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{40}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Furthermore, there was no<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">indication</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>of excess harm in terms of clinical events like cardiac death or MI in the PCI arm, the</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>authors</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>noted</span><span class="NormalTextRun SCXW62831797 BCX0">. </span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="1879730765" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{42}"><span class="NormalTextRun SCXW62831797 BCX0">The findings suggest that PCI was superior to OMT alone for symptom relief and improved QoL in those with a single CTO and no other significant coronary lesion, the researchers concluded.</span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="201485295" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{44}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">“This<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">may support the offer of revascularization for improvement of symptom and QoL in severely symptomatic CCS patients with a CTO rather than long-term antianginal medication</span><span class="NormalTextRun SCXW62831797 BCX0">,” they<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">added.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" xml:lang="EN-US" lang="EN-US" paraid="1427044693" paraeid="{409fdae9-8f5c-4506-b757-e17bd5916aa3}{164}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Werner</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>and</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>colleagues</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>went on to note that the findings are hypothesis-generating and pushed for further randomized trials to better<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">determine</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>which patients would benefit most from CTO PCI for symptom relief. They lamented that “a prognostic impact in this typically low-risk population within an RCT will be difficult to prov</span><span class="NormalTextRun SCXW62831797 BCX0">e.”</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="2098239688" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{53}"><strong><span class="NormalTextRun SCXW62831797 BCX0">Source:</span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" paraid="2002600166" paraeid="{31dfea45-8ae1-42c6-825e-4b2fb754af5a}{55}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">Werner GS, Kim JH, Hildick-Smith D, et a</span><span class="NormalTextRun SCXW62831797 BCX0">l.<span> </span></span><span class="NormalTextRun SCXW62831797 BCX0">Quality of Life After Percutaneous Coronary Intervention or Medical Therapy for Chronic Total Coronary Occlusions</span><span class="NormalTextRun SCXW62831797 BCX0">:</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>EUROCTO and DECISION-CTO Meta-Analysis</span><span class="NormalTextRun SCXW62831797 BCX0">.<span> </span></span></span><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0">J Am Coll<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW62831797 BCX0">Cardiol</span><span class="NormalTextRun SCXW62831797 BCX0">.</span></span><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW62831797 BCX0"><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>2026</span><span class="NormalTextRun SCXW62831797 BCX0"><span> </span>April 13</span><span class="NormalTextRun SCXW62831797 BCX0">; DOI: 10.1016/j.jacc.2026.02.5099.</span></span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW62831797 BCX0"> <p class="Paragraph SCXW62831797 BCX0" xml:lang="EN-US" lang="EN-US" paraid="489731242" paraeid="{409fdae9-8f5c-4506-b757-e17bd5916aa3}{177}"><strong><span class="NormalTextRun SCXW62831797 BCX0">Image Credit: Damian – stock.adobe.com</span><span class="EOP Selected SCXW62831797 BCX0" data-ccp-props="{}"> </span></strong></p> </div>