Abstract 15899: Percutaneous Revascularization of Chronic Total Occlusions Results in Improved Clinical Outcomes: A Meta-Analysis of the Available Literature
Chronic total occlusions (CTOs) represent the most complex and challenging coronary lesions for PCI. PCI for a CTO is a high risk procedure and the long term benefits of a successful percutaneous CTO recanalization over the medical management alone are not clear, as the studies have shown conflicting results in the past. The goal of this analysis was to clarify this issue by performing a meta-analysis of the available literature. Using major electronic data bases, we searched for studies (randomized or observational) comparing cardiac death, major adverse cardiovascular events (MACE) and target vessel revascularization (TVR) between patients who underwent PCI recanalization of CTOs versus those treated with medical management alone. We identified 22 observational studies comparing the desired clinical parameters between patients with successful CTO recanalization and those managed conservatively as a result of attempted but failed PCI. The total number of patients observed in all of the studies was 12,134 and the mean time of follow up was 3.7+/-2.1 years. Our results indicated that successful recanalization of a CTO results in improved cardiac mortality (RR of 0.56, CI 0.47-0.68, p <0.001), lower rates of MACE (RR of 0.70, CI 0.60-0.83, p <0.001) and reduced needs for subsequent CABG (RR of 0.28, CI 0.24-0.32, p <0.001). The difference in long-term mortality remained statistically significant even after the adjustment for procedure related complications and in-hospital deaths. We did not find difference in outcomes with regard to duration of a CTO (<3 months versus >3 months); however, as compared to angioplasty alone, stent placement decreased the rates of subsequent TVR in patients with successful PCI. As compared to conservative management, successful PCI recanalization of a CTO appears to be associated with improved long-term clinical outcomes; however, randomized controlled trials are needed to further confirm these results.
- © 2012 by American Heart Association, Inc.