Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: A meta‐analysis comparing successful versus failed percutaneous intervention for chronic total occlusion

Khan, Muhammad Fahad; Wendel, Christopher; Thai, Hoang; Movahed, Mohammad Reza

doi:10.1002/ccd.24863

Cited by 131 publications

(60 citation statements)

References 49 publications

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“…Finally, increasingly more studies provide data on the role of CTO as an predictor of sudden cardiac death, and long-term mortality [18]. In a recent meta-analysis of 23 observational studies, Khan et al [19]. found that successful recanalization of a CTO resulted in improved all-cause mortality, and lower rates of major adverse cardiac events.…”

Section: Discussionmentioning

confidence: 99%

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

et al. 2017

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Background: Multivessel disease (MVD) is a significant risk factor in patients with acute ST-segment elevation myocardial infarction (STEMI (OR 2.07, p = 0.002), whereas triple vessel disease was not (OR 1.27, p = 0.358). The other independent predictors of mortality were: age, anterior myocardial infarction, and PCI failure. Conclusions:The presence of CTO is an independent predictor of the long-term mortality in STEMI patients treated with primary PCI. (Cardiol J 2017; 24, 2: 117-124)

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Section: Discussionmentioning

confidence: 99%

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

et al. 2017

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“…21 Moreover, previous studies focused on the association of successful CTO revascularization with clinical outcome compared with failed PCI among patients who underwent PCI. 2-5, 22 Therefore, we investigated the clini- …”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…22 To date, most observational studies in which successful CTO recanalization was compared with failed CTO-PCI in a head-to-head fashion did not include patients managed medically without a CTO-PCI attempt. Accordingly, the strengths of our study may reflect the purely clinical significance of PCI as a planned treatment strategy by comparison with medical management alone for the treatment of CTO.…”

Section: Disclosures/grant Supportmentioning

confidence: 99%

Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion　– A Propensity-Matched Analysis –

Yang

Kim

Jang

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp medical therapy (OMT). 5,9 Current guidelines recommend that PCI for CTO is reasonable (Class IIa) in patients with appropriate indications and suitable anatomy when performed by operators with appropriate expertise and can have >80% success rate. 10,11 However, to date, no observational studies or randomized controlled trials have been performed in which CTO recanalization was compared with planned medical management in a head-to-head fashion. Therefore, we investigated the clinical outcomes of OMT in patients with CTO compared with those of PCI in the drug-eluting stent (DES) era.he management of coronary chronic total occlusion (CTO) has remained a challenge despite the advent of wires, devices and imaging modalities. 1 Although there have been numerous studies to determine the most appropriate treatment strategy, such as the retrograde approach, for CTO lesions, studies have focused on the association of successful recanalization with clinical outcome. 2-5 Furthermore, 20-35% of CTO cases were not revascularized by percutaneous coronary intervention (PCI); 6-8 in a substantial portion of cases, PCI is not attempted, and patients are treated with optimal Background: Limited data are available on the long-term clinical outcomes of coronary chronic total occlusion (CTO) patients who receive optimal medical therapy (OMT) compared with percutaneous coronary intervention (PCI).

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“…In non-randomized trials, successful recanalization of these CTOs has shown to improve survival, cardiac function and overall quality of life [2,[4][5][6][7]. Nevertheless, 40% of these patients are treated medically or a large portion of these patients is referred for coronary artery bypass grafting (CABG) surgery, especially those with multivessel disease and a high syntax-score [3].…”

Section: Introductionmentioning

confidence: 99%

Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI

Godino¹,

Bassanelli²,

Economou

et al. 2013

International Journal of Cardiology

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To improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated guidewires (GWs), devices and techniques have been developed. However, such an abundant choice of materials confuses inexperienced operators. Therefore, the usefulness of a simple antegrade treatment algorithm with a limited set of GWs, for easy to intermediate lesions, was investigated. Between November 2011 and March 2013, 105 patients were included, who underwent CTO PCI following the algorithm. Lesions were classified according to the Multicenter CTO Registry of Japan score. Overall technical success was achieved in 77%. Study endpoint was successful GW crossing within 30 min and was reached in 57%. High success rates were achieved in easy (81%) and intermediate (64%) lesion types. In both types, a soft wire could successfully cross in 57% and 51% respectively, with the Fielder XT ® (Asahi Intecc Co.) capable of crossing most commonly (90%). The proposed treatment algorithm simplifies the percutaneous treatment of easy to intermediate CTO lesions. However, it merits further evaluation, especially for operators/centers who perform a low to intermediate amount of CTO PCI.

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Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: A meta‐analysis comparing successful versus failed percutaneous intervention for chronic total occlusion

Abstract: As compared to conservative management (as a result of failed intervention), successful PCI recanalization of a CTO appears to be associated with improved long-term clinical outcomes; however, randomized controlled trials (RCTs) are needed to further confirm these results.

Cited by 131 publications

References 49 publications

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion　– A Propensity-Matched Analysis –

Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI

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Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: A meta‐analysis comparing successful versus failed percutaneous intervention for chronic total occlusion

Abstract: As compared to conservative management (as a result of failed intervention), successful PCI recanalization of a CTO appears to be associated with improved long-term clinical outcomes; however, randomized controlled trials (RCTs) are needed to further confirm these results.

Cited by 131 publications

References 49 publications

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion – A Propensity-Matched Analysis –

Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI

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Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion　– A Propensity-Matched Analysis –