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Meta-Analysis
. 2019 Aug 9;21(10):42.
doi: 10.1007/s11883-019-0804-8.

Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis

Ka Hou Christien Li  1   2   3 , Ka Hei Gabriel Wong  1   2 , Mengqi Gong  4 , Tong Liu  4 , Guangping Li  4 , Yunlong Xia  5 , Jeffery Ho  2   6 , Luis Nombela-Franco  7 , Abhishek C Sawant  8 , Simon Eccleshall  9 , Gary Tse  1   2 , Vassilios S Vassiliou  10   11   12
Affiliations
Meta-Analysis

Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis

Ka Hou Christien Li et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option.

Recent findings: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle-Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment.

Keywords: Adverse outcomes; Chronic total occlusion; Mortality.

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Conflict of interest statement

K.H.C.L., G.W., M.G., T.L., G.L., Y.X., J.H., L.N.-F., A.C.S., S.E., G.T., and V.S.V. declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the study selection process
Fig. 2
Fig. 2
(a) Forest plots comparing risk of all-cause mortality events between OMT and PCI in patients with CTO. (b) Forest plots comparing risk of cardiac death between OMT and PCI in patients with CTO. (c) Forest plots comparing risk of CVA/stroke events between OMT and PCI in patients with CTO. (d) Forest plots comparing risk of myocardial infarction between OMT and PCI in patients with CTO. (e) Forest plots comparing risk of repeated revascularization events between OMT and PCI in patients with CTO. (f) Forest plots comparing risk of MACE events between OMT and PCI in patients with CTO. (g) Forest plots comparing risk of MACCE events between OMT and PCI in patients with CTO
Fig. 2
Fig. 2
(a) Forest plots comparing risk of all-cause mortality events between OMT and PCI in patients with CTO. (b) Forest plots comparing risk of cardiac death between OMT and PCI in patients with CTO. (c) Forest plots comparing risk of CVA/stroke events between OMT and PCI in patients with CTO. (d) Forest plots comparing risk of myocardial infarction between OMT and PCI in patients with CTO. (e) Forest plots comparing risk of repeated revascularization events between OMT and PCI in patients with CTO. (f) Forest plots comparing risk of MACE events between OMT and PCI in patients with CTO. (g) Forest plots comparing risk of MACCE events between OMT and PCI in patients with CTO
Fig. 3
Fig. 3
(a) Trim-and-fill funnel plots with Egger’s regression test of all-cause mortality comparing between OMT and PCI in patients with CTO. (b) Trim-and-fill funnel plots with Egger’s regression test of cardiac death comparing between OMT and PCI in patients with CTO. (c) Trim-and-fill funnel plots with Egger’s regression test of CVA/stroke comparing between OMT and PCI in patients with CTO. (d) Trim-and-fill funnel plots with Egger’s regression test of MI comparing between OMT and PCI in patients with CTO. (e) Trim-and-fill funnel plots with Egger’s regression test of repeated revascularization comparing between OMT and PCI in patients with CTO
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References

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