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Meta-Analysis
. 2022 Jul;37(3):483-489.
doi: 10.1007/s12928-021-00819-x. Epub 2021 Oct 30.

Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention

Michael Megaly  1 , Mahmoud Khalil  2 , Mir B Basir  3 , Margaret B McEntegart  4 , James C Spratt  5 , Masahisa Yamane  6 , Etsuo Tsuchikane  7 , Bo Xu  8 , Khaldoon Alaswad  3 , Emmanouil S Brilakis  9
Affiliations
Meta-Analysis

Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention

Michael Megaly et al. Cardiovasc Interv Ther. 2022 Jul.

Abstract

Background: There are limited contemporary data on the impact of success vs. failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: We conducted a systematic review and a meta-analysis of contemporary studies that compared the outcomes in patients who underwent successful vs. failed contemporary (2010 onwards) CTO PCI. We performed a sensitivity analysis limited to studies that started enrollment after the publication of the hybrid algorithm in 2012.

Results: We included five studies with a total of 6,084 patients (successful CTO PCI n = 4,861, failed CTO PCI n = 1,223). During a median follow-up time of 12 months (range 6-60 months), successful CTO PCI was associated with a lower risk of major adverse cardiovascular events [OR: 0.61, 95% CI (0.41, 0.92), p = 0.02, I2 = 63%] and all-cause death [OR: 0.57, 95% CI (0.33, 0.99), p = 0.05, I2 = 60%]. Both groups had similar risk of myocardial infarction (MI) [OR 0.69, 95% CI (0.43, 1.10), p = 0.38, I2 = 80%], target vessel revascularization (TVR) [OR: 0.56, 95% CI (0.25, 1.27), p = 0.17, I2 = 80%], and stroke [OR: 0.52, 95% CI (0.14, 1.91), p = 0.33, I2 = 0%].

Conclusion: In contemporary practice, successful CTO PCI was associated with a lower incidence of MACE driven by lower all-cause mortality compared with failed CTO PCI at a median follow-up of 1 year.

Keywords: CTO; Chronic total occlusion; PCI; Percutaneous coronary intervention.

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