title: Meta-analysis of the long term effects of different interventions on chronic total coronary occlusions.
abstract: BACKGROUND
  Coronary chronic total occlusion (CTO) is the end stage of coronary artery atherosclerosis. CTO revascularization can be performed by percutaneous transluminal coronary angioplasty (PTCA), bare metal stent (BMS) or drug-eluting stent (DES). It is important to scientifically evaluate the effectiveness of CTO interventional treatments.
  
  
  METHODS
  Relevant studies of long term outcomes for several kinds of CTO treatments were examined. Data were extracted and assessed by two independent clinical experts, pooled and analyzed using meta-analysis.
  
  
  RESULTS
  (1) Totally 8 articles comparing outcomes between PTCA and BMS treatment were analyzed. Follow-up variables such as mortality, subsequent coronary artery bypass graft surgery (CABG), re-occlusion, re-stenosis and target lesion revascularization (TLR) were analyzed by meta-analysis. Compared with BMS intervention, PTCA was associated with significant higher rate of re-occlusion, re-stenosis, subsequent PTCA and TLR. (2) Totally 12 articles compared long term outcomes between BMS groups and DES groups, encompassed 3605 CTO patients. During the long-term follow-up, six variables as major adverse cardiac events (MACE), myocardial infarction, all-cause death, subsequent CABG, accumulated MACE-free survival rate, re-stenosis/re-occlusion rate were analyzed by meta-analysis. Compared with patients in DES groups, patients in BMS groups had significant higher MACE, subsequent CABG, re-stenosis/re-occlusion rate, TLR, target vessel revascularization, while lower MACE-free survival rate.
  
  
  CONCLUSIONS
  Incidence of re-occlusion, re-stenosis, subsequent PTCA and TLR were significantly lower for BMS implantation than for PTCA procedure. Variables, including MACE, subsequent CABG, re-stenosis/re-occlusion rate were higher while accumulated MACE-free survival rate was lower in BMS groups than in DES groups.
authors.affiliation: Department of Cardiology, Central Hospital, Fengxian District, Shanghai, China. yangss@medmail.com.cn
authors.forename: S-S
authors.initials: SS
authors.lastname: Yang
authors.forename: L
authors.initials: L
authors.lastname: Tang
authors.forename: G-H
authors.initials: GH
authors.lastname: Ge
authors.forename: J-W
authors.initials: JW
authors.lastname: Ma
authors.forename: Z-Y
authors.initials: ZY
authors.lastname: Qiao
authors.forename: Y-M
authors.initials: YM
authors.lastname: Hou
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: H-J
authors.initials: HJ
authors.lastname: Liu
authors.forename: H
authors.initials: H
authors.lastname: Cao
authors.forename: Z-M
authors.initials: ZM
authors.lastname: Hao
authors.forename: W-B
authors.initials: WB
authors.lastname: Cheng
authors.forename: H-W
authors.initials: HW
authors.lastname: Wang
authors.forename: R-Y
authors.initials: RY
authors.lastname: Zhang
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D054059:Coronary Occlusion / Q000601:surgery*; D006801:Humans; D015607:Stents