Megaly Michael, Khalil Mahmoud, Basir Mir B, McEntegart Margaret B, Spratt James C, Yamane Masahisa, Tsuchikane Etsuo, Xu Bo, Alaswad Khaldoon, Brilakis Emmanouil S
Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA.
Department of Medicine, Lincoln Medical Center, New York, NY, USA.
Cardiovasc Interv Ther. 2022 Jul;37(3):483-489. doi: 10.1007/s12928-021-00819-x. Epub 2021 Oct 30.
There are limited contemporary data on the impact of success vs. failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We conducted a systematic review and a meta-analysis of contemporary studies that compared the outcomes in patients who underwent successful vs. failed contemporary (2010 onwards) CTO PCI. We performed a sensitivity analysis limited to studies that started enrollment after the publication of the hybrid algorithm in 2012.
We included five studies with a total of 6,084 patients (successful CTO PCI n = 4,861, failed CTO PCI n = 1,223). During a median follow-up time of 12 months (range 6-60 months), successful CTO PCI was associated with a lower risk of major adverse cardiovascular events [OR: 0.61, 95% CI (0.41, 0.92), p = 0.02, I = 63%] and all-cause death [OR: 0.57, 95% CI (0.33, 0.99), p = 0.05, I = 60%]. Both groups had similar risk of myocardial infarction (MI) [OR 0.69, 95% CI (0.43, 1.10), p = 0.38, I = 80%], target vessel revascularization (TVR) [OR: 0.56, 95% CI (0.25, 1.27), p = 0.17, I = 80%], and stroke [OR: 0.52, 95% CI (0.14, 1.91), p = 0.33, I = 0%].
In contemporary practice, successful CTO PCI was associated with a lower incidence of MACE driven by lower all-cause mortality compared with failed CTO PCI at a median follow-up of 1 year.
关于慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）成功与失败对治疗结果影响的当代数据有限。
我们对当代研究进行了系统评价和荟萃分析，比较了接受成功与失败的当代（2010年起）CTO PCI患者的治疗结果。我们进行了一项敏感性分析，仅限于2012年混合算法发表后开始入组的研究。
我们纳入了5项研究，共6084例患者（成功的CTO PCI患者n = 4861例，失败的CTO PCI患者n = 1223例）。在中位随访时间12个月（范围6 - 60个月）内，成功的CTO PCI与较低的主要不良心血管事件风险相关[比值比（OR）：0.61，95%置信区间（CI）（0.41，0.92），p = 0.02，I² = 63%]和全因死亡风险相关[OR：0.57，95% CI（0.33，0.99），p = 0.05，I² = 60%]。两组心肌梗死（MI）风险相似[OR 0.69，95% CI（0.43，1.10），p = 0.38，I² = 80%]，靶血管血运重建（TVR）风险相似[OR：0.56，95% CI（0.25，1.27），p = 0.17，I² = 80%]，中风风险相似[OR：0.52，95% CI（0.14，1.91），p = 0.33，I² = 0%]。
在当代临床实践中，在1年的中位随访期内，与失败的CTO PCI相比，成功的CTO PCI因全因死亡率较低而与较低的主要不良心血管事件发生率相关。
