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Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention

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Abstract

Background

There are limited contemporary data on the impact of success vs. failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods

We conducted a systematic review and a meta-analysis of contemporary studies that compared the outcomes in patients who underwent successful vs. failed contemporary (2010 onwards) CTO PCI. We performed a sensitivity analysis limited to studies that started enrollment after the publication of the hybrid algorithm in 2012.

Results

We included five studies with a total of 6,084 patients (successful CTO PCI n = 4,861, failed CTO PCI n = 1,223). During a median follow-up time of 12 months (range 6–60 months), successful CTO PCI was associated with a lower risk of major adverse cardiovascular events [OR: 0.61, 95% CI (0.41, 0.92), p = 0.02, I2 = 63%] and all-cause death [OR: 0.57, 95% CI (0.33, 0.99), p = 0.05, I2 = 60%]. Both groups had similar risk of myocardial infarction (MI) [OR 0.69, 95% CI (0.43, 1.10), p = 0.38, I2 = 80%], target vessel revascularization (TVR) [OR: 0.56, 95% CI (0.25, 1.27), p = 0.17, I2 = 80%], and stroke [OR: 0.52, 95% CI (0.14, 1.91), p = 0.33, I2 = 0%].

Conclusion

In contemporary practice, successful CTO PCI was associated with a lower incidence of MACE driven by lower all-cause mortality compared with failed CTO PCI at a median follow-up of 1 year.

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Abbreviations

CTO:

Chronic total occlusion

PCI:

Percutaneous coronary intervention

MI:

Myocardial infarction

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Authors and Affiliations

  1. Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA

    Michael Megaly

  2. Department of Medicine, Lincoln Medical Center, New York, NY, USA

    Mahmoud Khalil

  3. Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA

    Mir B. Basir & Khaldoon Alaswad

  4. Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK

    Margaret B. McEntegart

  5. Department of Cardiology, St. George’s University Hospitals NHS Foundation Trust, London, UK

    James C. Spratt

  6. Department of Cardiology, Sayama Hospital, Saitama, Japan

    Masahisa Yamane

  7. Department of Cardiology, Toyohashi Heart Center, Aichi, Japan

    Etsuo Tsuchikane

  8. Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Bo Xu

  9. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA

    Emmanouil S. Brilakis

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  1. Michael Megaly
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Correspondence to Emmanouil S. Brilakis.

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Conflict of interest

Khaldoon Alaswad: consulting/speaker honoraria from Boston Scientific, Cardiovascular Systems Inc, Abbott Vascular, Teleflex. Mir Basir: Consulting/Speaker Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, Zoll. Etsuo Tsuchikane: Consultant for Asahi Intecc, Nipro, KANEKA, and Boston Scientific. Emmanouil Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Elsevier, GE Healthcare, InfraRedx, Medicure, Medtronic, Opsens, Siemens, and Teleflex; research support from Regeneron; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health. Margaret McEntegart: Consulting/speaker honoraria Abbott Vascular, Biosensors, Boston Scientific, Medtronic, Shockwave Medical, Teleflex. All other authors have nothing to disclose.

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Megaly, M., Khalil, M., Basir, M.B. et al. Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention. Cardiovasc Interv and Ther 37, 483–489 (2022). https://doi.org/10.1007/s12928-021-00819-x

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  • DOI: https://doi.org/10.1007/s12928-021-00819-x

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