Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies.
OBJECTIVE
This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).


BACKGROUND
The safety profile of CTO PCI has received limited study.


METHODS
We conducted a meta-analysis of 65 studies published between 2000 and 2011 reporting procedural complications of CTO PCI. Data on the frequency of death, emergent coronary artery bypass graft surgery, stroke, myocardial infarction, perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected.


RESULTS
A total of 65 studies with 18,061 patients and 18,941 target CTO vessels were included. Pooled estimates of outcomes were as follows: angiographic success 77% (95% confidence interval [CI]: 74.3% to 79.6%); death 0.2% (95% CI: 0.1% to 0.3%); emergent coronary artery bypass graft surgery 0.1% (95% CI: 0.0% to 0.2%); stroke <0.01% (95% CI: 0.0% to 0.1%); myocardial infarction 2.5% (95% CI: 1.9% to 3.0%); Q-wave myocardial infarction 0.2% (95% CI: 0.1% to 0.3%); coronary perforation 2.9% (95% CI: 2.2% to 3.6%); tamponade 0.3% (95% CI: 0.2% to 0.5%); and contrast nephropathy 3.8% (95% CI: 2.4% to 5.3%). Compared with successful procedures, unsuccessful procedures had higher rates of death (0.42% vs. 1.54%, p < 0.0001), perforation (3.65% vs. 10.70%, p < 0.0001), and tamponade (0% vs. 1.65%, p < 0.0001). Among 886 lesions treated with the retrograde approach, success rate was 79.8% with no deaths and low rates of emergent coronary artery bypass graft surgery (0.17%) and tamponade (1.2%).


CONCLUSIONS
CTO PCI carries low risk for procedural complications despite high success rates.
Veterans Administration North Texas Healthcare System, Dallas, Texas, USA.
Vishal G
VG
Patel
Kimberly M
KM
Brayton
Aracely
A
Tamayo
Owen
O
Mogabgab
Tesfaldet T
TT
Michael
Nathan
N
Lo
Mohammed
M
Alomar
Deborah
D
Shorrock
Daisha
D
Cipher
Shuaib
S
Abdullah
Subhash
S
Banerjee
Emmanouil S
ES
Brilakis
D000368:Aged; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D011832:Radiation Injuries / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media