Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Megaly, Michael; Saad, Marwan; Tajti, Péter; Burke, M. Nicholas; Chavez, Ivan; Gössl, Mario; Lips, Daniel; Mooney, M.; Poulose, Anil; Sorajja, Paul; Traverse, Jay H.; Wang, Yale; Kohl, Louis P.; Bradley, Steven M; Brilakis, Emmanouil S.

doi:10.1111/joic.12538

Cited by 55 publications

(33 citation statements)

References 48 publications

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“…Several observational studies 26–31 and two RCTs 32,33 have reported that successful CTO PCI is associated with improvement in the quality of life, reduced need for CABG, improved left ventricular (LV) function, and LV reverse remodeling compared with failed revascularization. The retrograde approach is currently an essential tool for achieving high success rates, especially in complex lesions where the antegrade approach is not technically feasible or fails 34 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Megaly

Ali

Saad

et al. 2019

Cathet Cardio Intervent

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Objectives The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. Methods We conducted a meta‐analysis of studies published between 2000 and August 2019 comparing the in‐hospital and long‐term outcomes with retrograde versus antegrade CTO PCI. Results Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J‐CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in‐hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in‐hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41–4.51, p = .002), and contrast‐induced nephropathy (OR 2.12, 95% CI 1.47–3.08; p < .001). During a mean follow‐up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84–3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1–3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49–2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33–3.28, p = .001). Conclusions Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long‐term adverse events.

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Section: Discussionmentioning

confidence: 99%

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Megaly

Ali

Saad

et al. 2019

Cathet Cardio Intervent

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“…Michael Megaly et al and showed a statistically signi cant increase in LVEF (3.8%, 95% CI 3.0-4.7, P < 0.0001) as compared with baseline [13] . Additionally, in our study, lower LVEF (LVEF 0.5) and LM disease predicted a worse probability for cardiac death.…”

Section: Discussionmentioning

confidence: 91%

The Impact of Successful Chronic Total Occlusion Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Real World

Gong

Zhou

Ding

et al. 2020

Preprint

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Backgroud: Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions; the optimal treatment strategy for CTO has not been well established. We sought to examine the impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world.Methods: A total of 592 consecutive patients with CTO in Beijing Friendship Hospital from June 2017 to December 2019 were enrolled. 29 patients were excluded due to Coronary artery bypass grafting (CABG), 301 patients were revascularized by PCI (CTO-R group) and 262 were not revascularized (CTO-NR group). The primary endpoint was cardiac death; Secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke. Results: Percent of Diabetes mellitus (53.4% vs 39.5), Chronic kidney disease (8.8% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease(96.2% vs 90%) and LM disease(25.2% vs 13.6%) was significantly higher in the CTO-NR group than in success PCI group (all P<0.05). Moreover, the CTO-NR group has lower EF (0.58±0.11 vs 0.61±0.1, p=0.002) and FS (0.32±0.07 vs 0.33±0.07, p=0.003). At a median follow-up of 12 months, CTO-R was superior to CTO-NR in terms of cardiac death (adjusted hazard ratio [HR]: 0.32, 95% conference interval [CI] 0.11-0.94). The superiority of CTO-R was consistent for MACCE (HR: 0.57, 95% CI 0.37-0.87). At multivariable Cox hazards regression analysis, CTO-R remains one of the independent predictors of lower risk of cardiac death and MACCE.Conclusions: Successful revascularization by PCI offered CTO patients more clinical benefits. The presence of LVEF＜0.5 and LM-disease was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.

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“…22 A recent meta-analysis of 34 studies with a total of 2,804 patients, by Megaly et al, showed that successful revascularization of a CTO is associated with a significant increase in LVEF, especially in those with lower baseline values. 24…”

Section: Ventricular Function In Percutaneous Coronary Intervention Omentioning

confidence: 99%

“…Finally, of the most frequent extra-cardiac periprocedural complications, those related to vascular access are notable. In recent years, attention has been paid to the type of access,with the aim of minimizing the use of femoral access and of large introducer sheaths (8 Fr) 24.…”

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confidence: 99%

Percutaneous Coronary Intervention for Chronic Total Occlusion

Vescovo

Zivelonghi

Scott

et al. 2020

US Cardiology Review

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Treatment of coronary chronic total occlusions represents one of the major challenges in the field of interventional cardiology. This is due to the complexity of these procedures and to the relatively higher risk of complications. In recent years, the development of innovative techniques and the evolution of materials have produced significant progress in this field. Better procedural outcomes have been achieved, with fewer complications. This article highlights the most recent scientific evidence and techniques, with the intention to guide interventional cardiologists in optimal patient selection and procedure choice.

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Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Cited by 55 publications

References 48 publications

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Outcomes with retrograde versus antegrade chronic total occlusion revascularization

The Impact of Successful Chronic Total Occlusion Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Real World

Percutaneous Coronary Intervention for Chronic Total Occlusion

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