Meta-Analysis of Clinical Outcomes of Patients Who Underwent Percutaneous Coronary Interventions for Chronic Total Occlusions

Christakopoulos, Georgios E.; Christopoulos, Georgios; Carlino, Mauro; Jeroudi, Omar M.; Roesle, Michele; Rangan, Bavana V.; Abdullah, Shuaib; Grodin, Jerrold; Kumbhani, Dharam J.; Vo, Minh; Luna, Michael; Alaswad, Khaldoon; Karmpaliotis, Dimitri; Rinfret, Stéphane; García, Santiago; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1016/j.amjcard.2015.02.038

Cited by 217 publications

(131 citation statements)

References 21 publications

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“…10 This finding, however, needs to be confirmed in prospective, randomized, controlled clinical trials. Two such trials are currently ongoing: the EuroCTO (a randomized, multicenter trial to evaluate the utilization of revascularization or optimal medical therapy for the treatment of chronic total coronary occlusions; ClinicalTrials.gov number, NCT01760083) and the DECISION-CTO (drug-eluting stent implantation versus optimal medical treatment in patients with chronic total occlusion; ClinicalTrials.gov number, NCT01078051) trials.…”

Section: N Benefits Of Cto-pcimentioning

confidence: 99%

“…9 The main reason for performing CTO-PCI is to improve patient symptoms: CTO-PCI has been shown to significantly improve angina, 10 dyspnea, refractory arrhythmias, and even depression. 11 In patients without symptoms, the threshold for performing coronary revascularization including CTO-PCI should be considerably higher, yet patients with large areas of ischemia (eg, ischemic burden .12.5%) could also derive benefit from CTO revascularization.…”

Section: N Benefits Of Cto-pcimentioning

confidence: 99%

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Update in Chronic Total Occlusion Percutaneous Coronary Interventions

Brilakis¹,

Burke²

2017

Journal of the Minneapolis Heart Institute Foundation

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Outcomes of chronic total occlusion-percutaneous coronary intervention have significantly improved in recent years. Chronic total occlusion-percutaneous coronary intervention can provide significant clinical benefits, such as angina reduction. At experienced centers, high success rates can currently be achieved, with use of all chronic total occlusion crossing techniques (antegrade wire escalation, antegrade dissection/ reentry, and the retrograde approach) orchestrated by use of procedural algorithms, such as the hybrid algorithm. Growth of chronic total occlusion-percutaneous coronary intervention is also fueled by continuous development of novel equipment, such as guidewires, microcatheters, support catheters, and dissection/reentry equipment. Readiness and ability to treat complications, such as perforation and donor vessel closure, is critical for all centers performing the procedure. Chronic total occlusionpercutaneous coronary intervention is a powerful and continuously developing tool for achieving complete coronary revascularization.

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Section: N Benefits Of Cto-pcimentioning

confidence: 99%

Section: N Benefits Of Cto-pcimentioning

confidence: 99%

Update in Chronic Total Occlusion Percutaneous Coronary Interventions

Brilakis¹,

Burke²

2017

Journal of the Minneapolis Heart Institute Foundation

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“…Although there is evidence that multivessel revascularization in patients with STEMI might be beneficial,7 it remains unclear whether revascularization via PCI of an nIRA CTO, and in particular in patients with STEMI, is translated to improved outcomes. The current literature includes several small studies which suggest that successful revascularization of CTO lesions is associated with a lower risk of death, stroke, and coronary artery bypass grafting; less recurrent angina; and improvement of left ventricular ejection fraction (LVEF) 8, 9. However, a recent randomized prospective trial did not find benefit for patients with STEMI who had PCI of an nIRA CTO 10.…”

mentioning

confidence: 99%

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

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BackgroundStudies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not.Method and ResultsWe conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33).ConclusionsIn this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

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“…While the benefit of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has not yet been demonstrated in randomized controlled trials, several observational studies have shown that, as compared with failed procedures, successful CTO PCI is associated with significant clinical benefit (1). It is, therefore, imperative to maximize the likelihood of CTO PCI success.…”

mentioning

confidence: 99%