Director of the Center for Complex Coronary Interventions, Minneapolis Heart Institute, Chairman of the Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 East 28th Street #300, Minneapolis, MN 55407 USA.
J Invasive Cardiol. 2022 Nov;34(11):E763-E775. doi: 10.25270/jic/22.00119. Epub 2022 Oct 13.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes.
In this systematic review and meta-analysis, we queried PubMed, ScienceDirect, Cochrane Library, Web of Science, and Embase databases (last search: September 15, 2021). We investigated the impact of CTO-PCI on clinical events including all-cause mortality, cardiovascular death, myocardial infarction (MI), major adverse cardiovascular event (MACE), stroke, subsequent coronary artery bypass surgery, target-vessel revascularization, and heart failure hospitalizations. Pooled analysis was performed using a random-effects model.
A total of 58 publications with 54,540 patients were included in this analysis, of which 33 were observational studies of successful vs failed CTO-PCI, 19 were observational studies of CTO-PCI vs no CTO-PCI, and 6 were randomized controlled trials (RCTs). In observational studies, but not RCTs, CTO-PCI was associated with better clinical outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause mortality, MACE, and MI were 0.52 (95% CI, 0.42-0.64), 0.46 (95% CI, 0.37-0.58), 0.66 (95% CI, 0.50-0.86), respectively for successful vs failed CTO-PCI studies; 0.38 (95% CI, 0.31-0.45), 0.57 (95% CI, 0.42-0.78), 0.65 (95% CI, 0.42-0.99), respectively, for observational studies of CTO-PCI vs no CTO-PCI; 0.72 (95% CI, 0.39-1.32), 0.69 (95% CI, 0.38-1.25), and 1.04 (95% CI, 0.46-2.37), respectively for RCTs.
CTO-PCI is associated with better subsequent clinical outcomes in observational studies but not in RCTs. Appropriately powered RCTs are needed to conclusively determine the impact of CTO-PCI on clinical outcomes.
慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）可以改善患者症状，但它是否会影响后续的临床结局仍存在争议。
在本系统评价和荟萃分析中，我们检索了 PubMed、ScienceDirect、Cochrane 图书馆、Web of Science 和 Embase 数据库（最后检索日期：2021 年 9 月 15 日）。我们研究了 CTO-PCI 对包括全因死亡率、心血管死亡、心肌梗死（MI）、主要不良心血管事件（MACE）、卒中和随后的冠状动脉旁路移植术、靶血管血运重建和心力衰竭住院在内的临床事件的影响。使用随机效应模型进行汇总分析。
共有 58 篇文献纳入了 54540 名患者，其中 33 篇是 CTO-PCI 成功与失败的观察性研究，19 篇是 CTO-PCI 与非 CTO-PCI 的观察性研究，6 篇是随机对照试验（RCT）。在观察性研究中，但不是 RCT 中，CTO-PCI 与更好的临床结局相关。CTO-PCI 成功与失败的观察性研究中，全因死亡率、MACE 和 MI 的优势比（OR）和 95%置信区间（CI）分别为 0.52（95%CI，0.42-0.64）、0.46（95%CI，0.37-0.58）、0.66（95%CI，0.50-0.86）；CTO-PCI 与非 CTO-PCI 的观察性研究中，全因死亡率、MACE 和 MI 的 OR 和 95%CI 分别为 0.38（95%CI，0.31-0.45）、0.57（95%CI，0.42-0.78）、0.65（95%CI，0.42-0.99）；RCT 中，全因死亡率、MACE 和 MI 的 OR 和 95%CI 分别为 0.72（95%CI，0.39-1.32）、0.69（95%CI，0.38-1.25）和 1.04（95%CI，0.46-2.37）。
在观察性研究中，CTO-PCI 与更好的后续临床结局相关，但在 RCT 中则不然。需要进行适当规模的 RCT 来确定 CTO-PCI 对临床结局的影响。
