Ma Yingxu, Li Dongping, Li Jiayi, Li Yixi, Bai Fan, Qin Fen, Zhou Shenghua, Liu Qiming
Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
J Thorac Dis. 2018 May;10(5):2960-2967. doi: 10.21037/jtd.2018.04.140.
It was under debate whether chronic total occlusion (CTO) patients could benefit from percutaneous coronary intervention (PCI). We sought to compare clinical outcomes of PCI and optimal medical therapy (OMT) in these patients.
PubMed, Embase and Cochrane Library were searched for studies enrolling patients with CTO who accepted PCI or OMT. The meta-analysis was performed by using a random-effect model. In addition, subgroup analyses were performed, including patients after propensity-matching and patients with CTO in infarct-related artery (IRA), respectively.
We identified 5 studies enrolling 4,761 participants in this meta-analysis. In the main analysis, when compared with OMT, PCI was associated with significant improvement in all-cause death [risk ratio (RR) 0.41, 95% CI: 0.35-0.48], cardiac death (RR 0.44, 95% CI: 0.35-0.55) and major adverse cardiac events (MACE) (RR 0.64, 95% CI: 0.43-0.97). But there were no differences in myocardial infarction (MI) and stroke. The results of the propensity-matched subgroup were somewhat consistent with those of the main analysis (all-cause death: RR 0.57, 95% CI: 0.26-0.89; MI: RR 0.54, 95% CI: 0.32-0.77; and MACE: RR 0.76, 95% CI: 0.33-1.18). In IRA subgroup, PCI reduced risks of mortality (all-cause death: RR 0.41, 95% CI: 0.34-0.49; cardiac death: RR 0.44, 95% CI: 0.35-0.56) and MACE (RR 0.71, 95% CI: 0.46-1.10). But no difference was observed in MI.
PCI was associated with improved survival and reduced MACE relative to OMT.
慢性完全闭塞（CTO）患者是否能从经皮冠状动脉介入治疗（PCI）中获益一直存在争议。我们试图比较这些患者接受PCI和最佳药物治疗（OMT）的临床结果。
检索PubMed、Embase和Cochrane图书馆，查找纳入接受PCI或OMT的CTO患者的研究。采用随机效应模型进行荟萃分析。此外，分别对倾向匹配后的患者和梗死相关动脉（IRA）中患有CTO的患者进行亚组分析。
我们在这项荟萃分析中确定了5项研究，共纳入4761名参与者。在主要分析中，与OMT相比，PCI与全因死亡[风险比（RR）0.41，95%可信区间：0.35 - 0.48]、心源性死亡（RR 0.44，95%可信区间：0.35 - 0.55）和主要不良心脏事件（MACE）（RR 0.64，95%可信区间：0.43 - 0.97）的显著改善相关。但在心肌梗死（MI）和中风方面没有差异。倾向匹配亚组的结果与主要分析的结果有些一致（全因死亡：RR 0.57，95%可信区间：0.26 - 0.89；MI：RR 0.54，95%可信区间：0.32 - 0.77；MACE：RR 0.76，95%可信区间：0.33 - 1.18）。在IRA亚组中，PCI降低了死亡风险（全因死亡：RR 0.41，95%可信区间：0.34 - 0.49；心源性死亡：RR 0.44，95%可信区间：0.35 - 0.56）和MACE（RR 0.71，95%可信区间：0.46 - 1.10）。但在MI方面未观察到差异。
与OMT相比，PCI与生存率提高和MACE减少相关。
