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Year : 2023  |  Volume : 24  |  Issue : 2  |  Page : 104-108

Meta-analysis Comparing long-term clinical outcomes of percutaneous coronary intervention versus no intervention in patients with chronic total occlusion

1 Department of Cardiothoracic, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
2 Department of Cardiothoracic, Freeman Hospital, Newcastle-Upon-Tyne; Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire, United Kingdom
3 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
4 Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire, United Kingdom
5 Department of Cardiothoracic, Freeman Hospital; Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne; School of Medicine, University of Sunderland, United Kingdom

Correspondence Address:
Prof. Mohaned Egred
Freeman Hospital, Newcastle Upon Tyne
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/heartviews.heartviews_82_22

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Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has substantially improved due to increasing operator experience and advancements in equipment, techniques, and management algorithms. However, the overall benefit of CTO PCI remains controversial, particularly since only a few randomized trials have been reported to date. Methods: We performed a meta-analysis to evaluate the efficacy of CTO PCI. The study outcomes were the occurrence of all-cause mortality, myocardial infarction, repeat revascularization, stroke, or freedom from angina at the longest documented follow-up period. Results: In five trials including 1790 patients, the mean age was 63 ± 10 years, 17% were female, with a median follow-up of 2.9 years. The procedural success rate ranged from 73% to 97% and the right coronary artery was the most involved artery (52%). There was no significant difference between CTO PCI and no intervention regarding all-cause mortality (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.49–2.47, P = 0.82), myocardial infarction (OR: 1.20, 95% CI: 0.81–1.77, P = 0.36), repeat revascularization (OR: 0.67, 95% CI: 0.40–1.14, P = 0.14), or stroke (OR: 0.60, 95% CI: 0.26–1.36, P = 0.22). In two trials including 686 patients, significantly more patients were free of angina at 1 year, defined as the Canadian Cardiovascular Society grading of angina pectoris Grade 0, in the CTO PCI group compared to the no intervention group (OR: 0.52, 95% CI: 0.35–0.76, P < 0.001). Meta-regression analyses based on various trial-level covariates (gender, diabetes, previous myocardial infarction, PCI or coronary artery bypass graft, SYNTAX or J-CTO scores, and CTO-related artery percentages) did not suggest any statistically significant relationships. Conclusions: CTO PCI appears to have a similar efficacy profile compared to no intervention at long-term follow-up, but with a significant improvement of angina favoring PCI-treated patients. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.

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