Abdelaziz Ahmed, Elsayed Hanaa, Atta Karim, Mechi Ahmed, Kadhim Hallas, Aboutaleb Aya Moustafa, Elaraby Ahmed, Hafez Abdelrahman, Bakr Ali, Mohamed Rzk Fayed, Elshahat Ahmed, Bakr Mohammed, Zawaneh Emad Addin, Ezzat Mahmoud, Abdelaziz Mohamed, Fadel Shaimaa, Ghaith Hazem S, Singer Emad, Suppah Mustafa
Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Curr Probl Cardiol. 2023 Nov;48(11):101890. doi: 10.1016/j.cpcardiol.2023.101890. Epub 2023 Jun 18.
The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.
在慢性完全闭塞（CTO）患者中使用经皮冠状动脉介入治疗（PCI）仍是一个有争议的话题，与非CTO病变相比，不同研究报告的结果相互矛盾。这项荟萃分析旨在阐明CTO病例与非CTO病变相比，PCI在短期和长期的临床结果。检索了PubMed、Scopus、Web of Science、Ovid和Cochrane Central，直至2023年3月，以查找有关CTO与非CTO病变中PCI短期和长期结果的相关研究。使用STATA 17 MP，在随机的Der-Simonian lair效应模型中，将二分数据合并为比值比（OR）及其95%置信区间（CI）。纳入了八项研究，共690123名患者。在短期结果方面，CTO PCI与更高的血管穿孔率（OR = 2.16，95% CI：1.31 - 3.57）和心脏压塞率（OR = 5.19，95% CI：4.29 - 6.28）相关。此外，CTO PCI的手术成功率较低（OR = 0.84，95% CI：0.73 - 0.96）。此外，从长期来看，CTO PCI的主要不良心血管事件（MACE）发生率较高（OR = 1.02，95% CI：1.01 - 1.04），然而，其心源性死亡率较低（OR = 0.61，95% CI：0.38 - 0.98），其他报告的结果无显著差异。我们的研究结果强调了在短期内使用PCI治疗CTO病变所面临的挑战和不良后果。这表明介入心脏病学家在对CTO病变进行PCI之前应仔细评估风险和益处。
