Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been associated with clinical benefit. There are no randomized controlled trials on long-term clinical outcomes after CTO PCI, limiting the available evidence to observational cohort studies. We sought to perform a weighted meta-analysis of the long-term outcomes of successful versus failed CTO PCI. A total of 25 studies, published from 1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were included. We analyzed data on mortality, subsequent coronary artery bypass grafting (CABG), myocardial infarction, major adverse cardiac events, angina pectoris, stroke, and target vessel revascularization using random-effects models. Procedural success was 71% (range 51% to 87%). During a weighted mean follow-up of 3.11 years, compared with unsuccessful, successful CTO PCI was associated with lower mortality (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.43 to 0.63), less residual angina (OR 0.38, 95% CI 0.24 to 0.60), lower risk for stroke (OR 0.72, 95% CI 0.60 to 0.88), less need for subsequent coronary artery bypass grafting (OR 0.18, 95% CI 0.14 to 0.22), and lower risk for major adverse cardiac events (0.59, 95% CI 0.44 to 0.79). There was no difference in the incidence of target vessel revascularization (OR 0.66, 95% CI 0.36 to 1.23) or myocardial infarction (OR 0.73, 95% CI 0.52 to 1.03). Outcomes were similar in patients who underwent balloon angioplasty only or stenting with bare metal or drug-eluting stents. Compared with failed procedures, successful CTO PCIs are associated with a lower risk of death, stroke, and coronary artery bypass grafting and less recurrent angina pectoris.
Bibliographical noteFunding Information:
Dr. Kumbhani: honoraria: American College of Cardiology, Somahlution; Dr. Vo: speaking fees and proctoring honoraria from Boston Scientific; Dr. Alaswad: consulting fees from Terumo, Asahi, and Boston Scientific; consultant, no financial, Abbott Laboratories; Dr. Karmpaliotis: honoraria from Abbott Vascular, Boston Scientific, Asahi, and Medtronic; Dr. Rinfret has received speaker and proctorship honoraria from Boston Scientific (BridgePoint Medical), Abbott Vascular Canada, Medtronic Canada, and Terumo US. He currently holds research support for Medtronic Canada and Abbott Vascular Canada; Dr. Banerjee: research grants from Gilead and the Medicines Company ; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel; Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St Jude Medical, and Terumo; research support from Guerbet and InfraRedx ; spouse is employee of Medtronic. Drs Christakopoulos, Christopoulos, Carlino, Jeroudi, Abdullah, Grodin, Luna, and Garcia and Roesle and Rangan declare no conflict of interest.
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