title: Meta-analysis of clinical outcomes of patients who underwent percutaneous coronary interventions for chronic total occlusions.
abstract: Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been associated with clinical benefit. There are no randomized controlled trials on long-term clinical outcomes after CTO PCI, limiting the available evidence to observational cohort studies. We sought to perform a weighted meta-analysis of the long-term outcomes of successful versus failed CTO PCI. A total of 25 studies, published from 1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were included. We analyzed data on mortality, subsequent coronary artery bypass grafting (CABG), myocardial infarction, major adverse cardiac events, angina pectoris, stroke, and target vessel revascularization using random-effects models. Procedural success was 71% (range 51% to 87%). During a weighted mean follow-up of 3.11 years, compared with unsuccessful, successful CTO PCI was associated with lower mortality (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.43 to 0.63), less residual angina (OR 0.38, 95% CI 0.24 to 0.60), lower risk for stroke (OR 0.72, 95% CI 0.60 to 0.88), less need for subsequent coronary artery bypass grafting (OR 0.18, 95% CI 0.14 to 0.22), and lower risk for major adverse cardiac events (0.59, 95% CI 0.44 to 0.79). There was no difference in the incidence of target vessel revascularization (OR 0.66, 95% CI 0.36 to 1.23) or myocardial infarction (OR 0.73, 95% CI 0.52 to 1.03). Outcomes were similar in patients who underwent balloon angioplasty only or stenting with bare metal or drug-eluting stents. Compared with failed procedures, successful CTO PCIs are associated with a lower risk of death, stroke, and coronary artery bypass grafting and less recurrent angina pectoris.
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Department of Cardiovascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Jeroudi
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Shuaib
authors.initials: S
authors.lastname: Abdullah
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: Department of Cardiovascular Diseases, University of Manitoba, Manitoba, Canada.
authors.forename: Minh
authors.initials: M
authors.lastname: Vo
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Luna
authors.affiliation: Department of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Department of Cardiovascular Diseases, Columbia University, New York, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Department of Cardiovascular Diseases, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Stephane
authors.initials: S
authors.lastname: Rinfret
authors.affiliation: Department of Cardiovascular Diseases, Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome