E-31 | Meta-analysis of Chronic Total Occlusion Percutaneous Coronary Intervention vs. Medical Management Only in Observational Studies and Randomized Controlled Trials
Year: 2022
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, it remains controversial whether CTO PCI improves clinical events.MethodsWe performed a systematic review and a meta-analysis on PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect for studies that compared the clinical outcomes of CTO PCI versus no CTO PCI (medical management only) and reported clinical events.ResultsA total of 25 studies were included in the meta-analysis, of which 19 were observational studies, and 6 were randomized controlled trials (RCTs). CTO PCI was performed in 45% of the patients; 78% were men, median age was 64 years and 27% had prior PCI. The CTO target vessel was the left anterior descending artery in 31%, left circumflex in 24%, and right coronary artery in 45%. During a median follow-up of 2.6 years, 9% of the patients underwent coronary artery bypass grafting. Compared with no CTO PCI, CTO PCI was associated with significantly better clinical outcomes in observational studies: 62% lower incidence of all-cause mortality, 58% lower incidence of cardiovascular mortality, 43% lower major adverse clinical events, and 35% lower incidence of myocardial infarction in observational studies. Clinical outcomes between CTO PCI and no CTO PCI were comparable in RCTs (Table), although the RCTs were likely underpowered.ConclusionsDisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; K. O. Tammam: Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. M. S. Megaly Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. N. A. Rafeh Nothing to disclose. BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, it remains controversial whether CTO PCI improves clinical events. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, it remains controversial whether CTO PCI improves clinical events. MethodsWe performed a systematic review and a meta-analysis on PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect for studies that compared the clinical outcomes of CTO PCI versus no CTO PCI (medical management only) and reported clinical events. We performed a systematic review and a meta-analysis on PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect for studies that compared the clinical outcomes of CTO PCI versus no CTO PCI (medical management only) and reported clinical events. ResultsA total of 25 studies were included in the meta-analysis, of which 19 were observational studies, and 6 were randomized controlled trials (RCTs). CTO PCI was performed in 45% of the patients; 78% were men, median age was 64 years and 27% had prior PCI. The CTO target vessel was the left anterior descending artery in 31%, left circumflex in 24%, and right coronary artery in 45%. During a median follow-up of 2.6 years, 9% of the patients underwent coronary artery bypass grafting. Compared with no CTO PCI, CTO PCI was associated with significantly better clinical outcomes in observational studies: 62% lower incidence of all-cause mortality, 58% lower incidence of cardiovascular mortality, 43% lower major adverse clinical events, and 35% lower incidence of myocardial infarction in observational studies. Clinical outcomes between CTO PCI and no CTO PCI were comparable in RCTs (Table), although the RCTs were likely underpowered. A total of 25 studies were included in the meta-analysis, of which 19 were observational studies, and 6 were randomized controlled trials (RCTs). CTO PCI was performed in 45% of the patients; 78% were men, median age was 64 years and 27% had prior PCI. The CTO target vessel was the left anterior descending artery in 31%, left circumflex in 24%, and right coronary artery in 45%. During a median follow-up of 2.6 years, 9% of the patients underwent coronary artery bypass grafting. Compared with no CTO PCI, CTO PCI was associated with significantly better clinical outcomes in observational studies: 62% lower incidence of all-cause mortality, 58% lower incidence of cardiovascular mortality, 43% lower major adverse clinical events, and 35% lower incidence of myocardial infarction in observational studies. Clinical outcomes between CTO PCI and no CTO PCI were comparable in RCTs (Table), although the RCTs were likely underpowered. Conclusions DisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; K. O. Tammam: Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. M. S. Megaly Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. N. A. Rafeh Nothing to disclose. K. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; K. O. Tammam: Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. M. S. Megaly Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. N. A. Rafeh Nothing to disclose.
Authors: Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Michael S. Megaly, Dimitrios Karmpaliotis, Wissam A. Jaber, William J. Nicholson, Kambis Mashayekhi, Gerald S. Werner, Margaret McEntegart, Seung W. Lee, Bo Xu, Scott A. Harding, Alexandre Avran, Ilias Nikolakopoulos, Evangelia Vemmou, Olga C. Mastrodemos, Bavana V. Rangan, Lorenzo Azzalini, Farouc A. Jaffer, Kevin J. Croce, Hsien-Li Kao, George Sianos, Masahisa Yamane, Eugene B. Wu, Etsuo Tsuchikane, Anastasios Milkas, Carlo Di Mario, Alfredo R. Galassi Prof, Roberto Garbo, Andrea Gagnor, Paul Knaapen, Khalid Omar Tammam, Yangsoo Jang, Byeong-Keuk Kim, Nidal Abi Rafeh, Emmanouil S. Brilakis
Institutions: Abbott Northwestern Hospital, Minneapolis Heart Institute Foundation, Henry Ford Health, Henry Ford Hospital, Morristown Medical Center, Atlantic Health System, Emory University Hospital, Emory Healthcare, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Klinikum Darmstadt, Golden Jubilee National Hospital, Fu Wai Hospital, Wellington Hospital, Institut Pasteur, Virginia Commonwealth University, Massachusetts General Hospital, Brigham and Women's Hospital, National Taiwan University Hospital, Aristotle University of Thessaloniki, Prince of Wales Hospital, Toyohashi Heart Center, Onze Lieve Vrouwziekenhuis Hospital, Royal Brompton Hospital, University of Catania, Ospedale San Giovanni Bosco, Amsterdam UMC Location Vrije Universiteit Amsterdam, International Medical Center in Jeddah, Yonsei University, Severance Hospital, North Oaks Health System
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,400
OpenAlex ID: W4280569006