Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis

Abstract

Background:The optimal treatment strategy of chronic total occlusion (CTO) is currently debated. This meta-analysis aimed to evaluate the long-term clinical outcomes of successful percutaneous coronary intervention (PCI) of CTO.Methods: Electronic databases were searched for studies comparing long-term outcomes between successful PCI in patients with CTO using drug-eluting stents and failed procedures. Meta-analysis was conducted with major adverse cardiac events (MACE) and all-cause mortality during the longest follow-up as endpoints. The combined hazard ratios (HRs) were applied to assess the correlation between successful CTO PCI and MACE/all-cause mortality.Results: Eight studies consisting of 6,211 patients published between 2012 and 2020 met our inclusion criteria, and the CTO PCI success rate was 81.2%. Patients in the failed group were much older, and more likely to have morbidities (hypertension and 2 prior myocardial infarction), reduced left ventricular ejection fraction, and severe lesion characteristics (multivessel disease and moderate/severe calcification). Pooled results indicated that successful CTO PCI was significantly associated with prognosis.Compared to failed recanalization, patients receiving successful procedures had an improved MACE (HR: 0.50, 95% CI: 0.40-0.61, p < 0.001). Subgroup analyses further revealed the prognostic value of successful CTO PCI. However, no difference was observed regarding all-cause mortality (HR: 0.79, 95% CI: 0.61-1.02, p = 0.074). Conclusions:The present study showed that CTO recanalization was associated with improved long-term outcomes. However, randomized trials are needed to confirm the results due to the mismatch of baseline characteristics.

Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

“…Since all unsuccessful PCIs were derived from PCI to CTO, we excluded unsuccessful PCI for CTO from the major complications. However, our success rate for CTO-PCI in this present study was 93.0% (280 successful PCI/ 301 CTO-PCI), which was higher than the success rate (81.2%) of the recent meta-analysis including 6211 CTO-PCI 45) . Moreover, there were several parameters with missing values such as BNP levels.…”

Percutaneous Coronary Intervention versus Optimal Medical Therapy in Patients with Chronic Total Occlusion: A Meta-Analysis

“…CTO-PCI is a complex coronary procedure: technical success rates depend on operators' experience and on trial design with about 85% in dedicated CTO registries, but only 64% in national reports [10,11]. Successful CTO-PCI was associated with a more favorable outcome compared to failed PCI attempts in prior observational studies and a pooled data analysis [2,[12][13][14][15][16][17]. The current European Society of Cardiology guidelines on myocardial revascularization or acute coronary syndrome (ACS) lack explicit and specific recommendations for the treatment of CTO despite a class IIa indication for revascularization in the case of refractory angina [8,18,19].…”

“…In this context, the authors want to point out that the present literature indicates considerably higher CTO-PCI success rates in dedicated registries by experienced operators [10,11,62,63]. The trend of successful revascularization contributing to a better prognosis might only reliably appear if patients survive the risky and complex CTO-PCI [2,[12][13][14][15][16][17]64,65]. The referral of CTO patients to experienced centers might be the preferred strategy to optimize interventional and clinical outcomes in this vulnerable cohort, but this requires prospective validation [20].…”