Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
Curr Atheroscler Rep. 2019 Aug 9;21(10):42. doi: 10.1007/s11883-019-0804-8.
Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option.
This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle-Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I index and Egger's regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment.
冠状动脉慢性完全闭塞（CTO）是一个重大的临床问题，传统上一直采用药物治疗或冠状动脉旁路移植术进行治疗。最近的研究已经检查了经皮冠状动脉介入治疗（PCI）作为一种替代选择。
本系统综述和荟萃分析比较了药物治疗与 PCI 治疗 CTO 的效果。从文献创建开始至 2019 年 3 月，在 PubMed 和 Embase 上检索了比较 CTO 患者药物治疗和 PCI 治疗的临床结局的研究。使用纽卡斯尔-渥太华量表评估纳入研究的质量。根据需要，通过 DerSimonian 和 Laird 随机或固定效应模型对结果进行汇总。通过 I 指数和 Egger 回归分别评估研究之间的异质性和发表偏倚。在筛选出的 703 项研究中，有 17 项研究最终纳入分析。这包括 11493 名参与者。与 PCI 相比，包括随机和观察性研究在内的药物治疗与全因死亡率（风险比 (RR) 1.99，95%CI 1.38-2.86）、心脏死亡率（RR 2.36（1.97-2.84））和主要不良心脏事件（RR 1.25（1.03-1.51））的风险显著增加。然而，两组之间心肌梗死和再次血运重建的发生率没有差异。单变量荟萃回归表明，多种协变量是心肌梗死和再次血运重建的独立调节因素，但不是心脏死亡和全因死亡率的独立调节因素。然而，当仅纳入随机研究时，总死亡率或心脏死亡率没有差异。在 CTO 中，当考虑随机和观察性研究时，与 PCI 治疗相比，药物治疗可能与更高的死亡率和心肌梗死风险相关。
