title: Meta-analysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy.
abstract: We performed a systematic review and meta-analysis comparing the all-cause mortality outcomes of successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) with unsuccessful CTO-PCI, using a stent-based strategy. Multiple studies comparing successful CTO-PCI with unsuccessful CTO-PCI have reported variable outcomes. No systematic review or meta-analysis has been performed after stenting became the default strategy for CTO-PCI. Searching major electronic databases, 64 studies were identified using the keywords "CTO," "PCI," and "mortality." Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method, 13 studies met the criteria for inclusion in the present meta-analysis. The short-term (≤30 days) and long-term (≥1 year) mortality outcomes were analyzed comparing successful CTO-PCI and unsuccessful CTO-PCI. Coronary perforation and its association with CTO-PCI success was analyzed. A significant reduction in short-term mortality was noted with successful CTO-PCI compared to unsuccessful CTO-PCI (odds ratio 0.218, 95% confidence interval 0.095 to 0.498, Z = -3.61, p <0.001). A similar, significant reduction in long-term mortality was noted with successful CTO-PCI compared to unsuccessful CTO-PCI (odds ratio 0.391, 95% confidence interval 0.311 to 0.493, Z = -7.957, p <0.001). A significant association was present between coronary perforation and unsuccessful CTO-PCI (odds ratio 0.168, 95% confidence interval 0.104 to 0.271, Z = -7.333, p <0.001). In conclusion, successful CTO-PCI using a predominantly stent-based strategy is associated with a significant reduction in short- and long-term mortality compared to unsuccessful CTO-PCI. Coronary perforation was associated with CTO-PCI failure.
authors: Cardiovascular Diseases, The Wright Center for Graduate Medical Education and Medicine, The Commonwealth Medical College, Scranton, Pennsylvania, USA. pancholys@gmail.com
authors: Samir B
authors: SB
authors: Pancholy
authors: Pranjal
authors: P
authors: Boruah
authors: Imdad
authors: I
authors: Ahmed
authors: Tak
authors: T
authors: Kwan
authors: Tejas M
authors: TM
authors: Patel
authors: Shigeru
authors: S
authors: Saito
mesh_terms: D002908:Chronic Disease; D054059:Coronary Occlusion / Q000401:mortality* / Q000601:surgery*; D014943:Global Health; D006801:Humans; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate / Q000639:trends