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Meta-Analysis
. 2022 Nov;34(11):E763-E775.
doi: 10.25270/jic/22.00119. Epub 2022 Oct 13.

A Systematic Review and Meta-Analysis of Clinical Outcomes of Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Michael Megaly, Dimitrios Karmpaliotis, Amirali Masoumi, Wissam A Jaber, William Nicholson, Stephane Rinfret, Kambis Mashayekhi, Gerald S Werner, Margaret McEntegart, Seung-Whan Lee, Jaikirshan J Khatri, Scott A Harding, Alexandre Avran, Farouc A Jaffer, Darshan Doshi, Hsien-Li Kao, Georgios Sianos, Masahisa Yamane, Anastasios Milkas, Lorenzo Azzalini, Roberto Garbo, Khalid Tammam, Nidal Abi Rafeh, Ilias Nikolakopoulos, Evangelia Vemmou, Bavana V Rangan, M Nicholas Burke, Santiago Garcia, Kevin J Croce, Eugene B Wu, Etsuo Tsuchikane, Carlo Di Mario, Alfredo R Galassi, Andrea Gagnor, Paul Knaapen, Yangsoo Jang, Byeong-Keuk Kim, Paul B Poommipanit, Emmanouil S Brilakis  1
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Free article
Meta-Analysis

A Systematic Review and Meta-Analysis of Clinical Outcomes of Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

Bahadir Simsek et al. J Invasive Cardiol. 2022 Nov.
Free article

Abstract

Objectives: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes.

Methods: In this systematic review and meta-analysis, we queried PubMed, ScienceDirect, Cochrane Library, Web of Science, and Embase databases (last search: September 15, 2021). We investigated the impact of CTO-PCI on clinical events including all-cause mortality, cardiovascular death, myocardial infarction (MI), major adverse cardiovascular event (MACE), stroke, subsequent coronary artery bypass surgery, target-vessel revascularization, and heart failure hospitalizations. Pooled analysis was performed using a random-effects model.

Results: A total of 58 publications with 54,540 patients were included in this analysis, of which 33 were observational studies of successful vs failed CTO-PCI, 19 were observational studies of CTO-PCI vs no CTO-PCI, and 6 were randomized controlled trials (RCTs). In observational studies, but not RCTs, CTO-PCI was associated with better clinical outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause mortality, MACE, and MI were 0.52 (95% CI, 0.42-0.64), 0.46 (95% CI, 0.37-0.58), 0.66 (95% CI, 0.50-0.86), respectively for successful vs failed CTO-PCI studies; 0.38 (95% CI, 0.31-0.45), 0.57 (95% CI, 0.42-0.78), 0.65 (95% CI, 0.42-0.99), respectively, for observational studies of CTO-PCI vs no CTO-PCI; 0.72 (95% CI, 0.39-1.32), 0.69 (95% CI, 0.38-1.25), and 1.04 (95% CI, 0.46-2.37), respectively for RCTs.

Conclusions: CTO-PCI is associated with better subsequent clinical outcomes in observational studies but not in RCTs. Appropriately powered RCTs are needed to conclusively determine the impact of CTO-PCI on clinical outcomes.

Keywords: percutaneous coronary intervention; systematic review; chronic total occlusion; clinical outcomes; meta-analysis.

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