A Systematic Review and Meta-Analysis of Clinical Outcomes of Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention
Bahadir Simsek, Spyridon Kostantinis, Judit Karácsonyi, Khaldoon Alaswad, Michael Megaly, Dimitrios Karmpaliotis, Amirali Masoumi, Wissam Jaber, William Nicholson, Stéphane Rinfret, Kambis Mashayekhi, Gerald S. Werner, Margaret McEntegart, Seung‐Whan Lee, Jaikirshan Khatri, Scott 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 García, Kevin Croce, Eugene B. Wu, Etsuo Tsuchikane, Carlo Di Mario, Alfredo R. Galassi, Andrea Gagnor, Paul Knaapen, Yangsoo Jang, Byeong‐Keuk Kim, Paul Poommipanit, Emmanouil S. Brilakis
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.