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Meta-Analysis
. 2018 Apr 13;7(8):e008415.
doi: 10.1161/JAHA.117.008415.

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Pedro A Villablanca  1 , Wilman Olmedo  2 , Michael Weinreich  2 , Tanush Gupta  2 , Divyanshu Mohananey  3 , Felipe N Albuquerque  4 , Ibrahim Kassas  1 , David Briceño  5 , Cristina Sanina  2 , Thomas A Brevik  2 , Emily Ong  2 , Harish Ramakrishna  6 , Michael Attubato  1 , Mark Menegus  2 , Jose Wiley  2 , Ankur Kalra  7
Affiliations
Meta-Analysis

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Pedro A Villablanca et al. J Am Heart Assoc. .

Abstract

Background: Studies have shown that chronic total occlusion (CTO) in a noninfarct-related artery in patients with ST-segment-elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct-related artery CTO in patients with ST-segment-elevation myocardial infarction translates to improved outcomes. We performed a meta-analysis to compare outcomes between patients presenting with ST-segment-elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct-related artery CTO versus those who did not.

Method and results: We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all-cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32-0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20-0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36-0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all-cause mortality (OR, 0.47; 95% CI, 0.22-1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41-1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56-2.27), and stroke (OR, 0.51; 95% CI, 0.20-1.33).

Conclusions: In this meta-analysis, CTO percutaneous coronary intervention of the noninfarct-related artery in patients presenting with ST-segment-elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

Keywords: ST‐segment–elevation myocardial infarction; chronic total occlusion; meta‐analysis; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Flow chart of the literature review. From 527 studies identified from the initial search, a total of 6 studies were included after screening titles and reviewing the full articles of potentially relevant studies. CTO indicates chronic total occlusion; PCI, percutaneous coronary intervention; STEMI, ST‐segment–elevation myocardial infarction.
Figure 2
Figure 2
A, Major adverse cardiovascular events; (B) all‐cause mortality; (C) cardiovascular mortality. Forest plot reporting the odds ratios in patients with ST‐segment–elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) of the chronic total occlusion (CTO) lesion vs no PCI of CTO lesion. Diamond indicates overall summary estimate for the analysis (width of the diamond represents the 95% confidence interval [CI]); width of the shaded square represents the size of the population).
Figure 3
Figure 3
A, Myocardial infarction; (B) repeat revascularization; (C) stroke; (D) heart failure readmission. Forest plot reporting the odds ratios in patients with ST‐segment–elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) of the chronic total occlusion (CTO) lesion vs no PCI of CTO lesion. Diamond indicates overall summary estimate for the analysis (width of the diamond represents the 95% confidence interval [CI]); width of the shaded square, size of the population).
See this image and copyright information in PMC

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