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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 SM  ;  Kambis Mashayekhi  ;  Gerald S. Werner  ;  Margaret McEntegart  ;  Seung-Whan Lee  ;  Jaikirshan J. Khatri  ;  Scott A. Harding  ;  Alexandre Avran  ;  Farouc A. Jaffer  ;  Darshan Doshi MS  ;  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 BDS MPH  ;  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 
 JOURNAL OF INVASIVE CARDIOLOGY, Vol.34(11) : E763-E775, 2022-11 
Journal Title
Issue Date
Coronary Occlusion* / surgery ; Humans ; Myocardial Infarction* / etiology ; Observational Studies as Topic ; Odds Ratio ; Percutaneous Coronary Intervention* / adverse effects ; Randomized Controlled Trials as Topic ; Treatment Outcome
percutaneous coronary intervention ; systematic review ; chronic total occlusion ; clinical outcomes ; meta-analysis
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
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