Coronary artery diseaseMeta-Analysis of Effect on Mortality of Percutaneous Recanalization of Coronary Chronic Total Occlusions Using a Stent-Based Strategy
Section snippets
Methods
Our meta-analysis followed the method outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.4 We searched the indexed studies using major databases, including PubMed, the Cochrane Library, and Google Scholar. The keywords included “chronic total occlusion,” “percutaneous coronary intervention,” and “outcomes.” Abstracts from major interventional cardiology meetings were searched using the same keywords.
The titles and abstracts of 64 relevant
Results
The search resulted in 64 studies. Of the 13 studies included in the present analysis, 65, 6, 7, 8, 9, 10 had reported the mortality outcomes at ≤30 days of follow-up, and 12 studies5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 17 had reported the mortality outcomes at ≥1 year of follow-up for patients with successful versus unsuccessful CTO-PCI. Of the 13 studies, 6 studies8, 9, 11, 13, 14, 17 were prospective and 7 studies5, 6, 7, 10, 12, 15, 16 were retrospective. The studies reported by Suero et al
Discussion
CTOs are encountered in approximately 20% of patients referred for coronary angiography22 and have been associated with worse long-term outcomes.23, 24 The advent of better equipment, including tapered-tipped guidewires,25 hydrophilically coated specialty microcatheters, and dedicated devices,26 and a better understanding of the substrate and increasing operator experience has led to an improvement in the antegrade CTO-PCI success rates. Increasing adoption of the retrograde technique27 has
Disclosures
The authors have no conflicts of interest to disclose.
References (30)
- et al.
Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis
Am Heart J
(2010) - et al.
Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: six-year clinical follow-up of the GISSOC trial
J Am Coll Cardiol
(2003) - et al.
Successful recanalization of chronic total occlusions is associated with improved long-term survival
JACC Cardiovasc Interv
(2012) - et al.
Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries 2002 to 2008: impact of novel guidewire techniques
JACC Cardiovasc Interv
(2009) - et al.
Comparison of safety, efficacy, and outcome of successful versus unsuccessful percutaneous coronary intervention in “true” chronic total occlusions
Am J Cardiol
(2008) - et al.
Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE)
J Am Coll Cardiol
(2003) - et al.
Long-term outcome of percutaneous coronary intervention for chronic total occlusions
JACC Cardiovasc Interv
(2011) - et al.
Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience
J Am Coll Cardiol
(2001) - et al.
Improvement in survival following successful percutaneous coronary intervention of coronary chronic total occlusions: variability by target vessel
JACC Cardiovasc Interv
(2008) - et al.
Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic
J Am Coll Cardiol
(2007)
Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry
J Am Coll Cardiol
Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention
JACC Cardiovasc Interv
Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques: results of the FAST-CTOs (Facilitated Antegrade Steering Technique in Chronic Total Occlusions) trial
JACC Cardiovasc Interv
Management of chronic total occlusion by percutaneous coronary intervention
Heart
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration
PLoS Med
Cited by (50)
Relation of Chronic Total Occlusion to In-Hospital Mortality in the Patients With Sudden Cardiac Arrest Due to Acute Coronary Syndrome
2019, American Journal of CardiologyComparison of successful percutaneous coronary intervention versus optimal medical therapy in patients with coronary chronic total occlusion
2019, Journal of CardiologyCitation Excerpt :A previous study showed that incomplete revascularization by PCI leaving untreated CTOs led to higher 3-year mortality [12]. Many studies comparing successful CTO PCI versus failed CTO PCI also showed successful CTO PCI was associated with improved survival [6–8]. However, these studies are not direct data comparing the CTO PCI to medical treatment which might be essential to make decision for interventional cardiologists when they encounter patients with CTOs.
Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence
2017, Journal of CardiologyCitation Excerpt :Some meta-analyses included studies that used balloon angioplasty only [31,48]; the results of such studies cannot be extrapolated to the contemporary era of advanced stent technology and use of aggressive antithrombotic therapy. In one meta-analysis, the authors adopted the fixed-effect model, rather than the random-effects model, for analysis of outcome endpoints, despite the non-uniform distribution of effect sizes [49]. Moreover, in two meta-analyses, substantial heterogeneity existed among the included studies, for analysis of the index outcome [31,50].
Dedicated CTO-PCI Centres: ‘If you Build it they will Come’
2016, Heart Lung and Circulation
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