Devireddy Rakesh R, Qaqish Omar, Pannikottu Kurian, Ramireddy Swetha, Kumar Awaneesh, Saad Chadi, Kambhatla Sujata, Kondur Ashok, George Nathan, Hasan Md Sakibur
Department of Internal Medicine, Garden City Hospital, MI, United States of America.
Department of Cardiology, Garden City Hospital, MI, United States of America.
Am Heart J Plus. 2023 Nov 6;36:100345. doi: 10.1016/j.ahjo.2023.100345. eCollection 2023 Dec.
Chronic total occlusion rotational atherectomy (CTO RA) is an emerging intervention in coronary artery disease (CAD), although data comparing its outcomes and complications with non-CTO RA are scarce. We sought to evaluate the outcomes of RA in CTO lesions compared to those in non-CTO lesions by performing a meta-analysis.
We conducted a systematic review and meta-analysis of studies comparing the clinical outcomes and complications between CTO RA and non-CTO RA in patients with CAD. We searched PUBMED, CINAHL, EMBASE and Cochrane Central Register of Clinical Trials for any studies that compared the outcomes of RA in CTO and non-CTO lesions. The outcomes analyzed included in-hospital major adverse cardiovascular events (MACE), target vessel revascularization (TVR), angiographic success, procedural success, periprocedural complications, coronary perforation, and all-cause mortality.
Four studies with a total of 1868 patients were included, spanning from 2018 to 2022, from Germany, Taiwan, and Korea. The median age of included patients was 71. The rate of the pooled results indicated a moderate, non-significant increase in in-hospital MACE and TVR for CTO RA compared to non-CTO RA. There was a small, non-significant decrease in angiographic and procedural success in CTO RA compared to non-CTO RA. CTO RA was associated with a non-significant increase in periprocedural complications and a significant increase in coronary perforation compared to non-CTO RA. All-cause mortality showed a non-significant increase in the CTO RA group.
This meta-analysis provides evidence that while CTO RA may be associated with a higher risk of coronary perforation, the risk of other outcomes including MACE, TVR, and all-cause mortality is not significantly different compared to non-CTO RA. More research is needed to further understand these relationships and to optimize treatment strategies in patients with CAD undergoing CTO RA.
慢性完全闭塞病变的旋磨术（CTO RA）是冠状动脉疾病（CAD）中一种新兴的干预手段，尽管将其结果和并发症与非CTO RA进行比较的数据很少。我们试图通过进行一项荟萃分析来评估CTO病变中RA与非CTO病变中RA的结果。
我们对比较CAD患者中CTO RA和非CTO RA的临床结果及并发症的研究进行了系统评价和荟萃分析。我们在PUBMED、CINAHL、EMBASE和Cochrane临床试验中央注册库中搜索了任何比较CTO和非CTO病变中RA结果的研究。分析的结果包括住院期间主要不良心血管事件（MACE）、靶血管再血管化（TVR）、血管造影成功、手术成功、围手术期并发症、冠状动脉穿孔和全因死亡率。
纳入了四项研究，共1868例患者，时间跨度为2018年至2022年，来自德国、台湾和韩国。纳入患者的中位年龄为71岁。汇总结果率表明，与非CTO RA相比，CTO RA的住院期间MACE和TVR有中度但无显著增加。与非CTO RA相比，CTO RA的血管造影和手术成功率有小幅但无显著下降。与非CTO RA相比，CTO RA与围手术期并发症无显著增加以及冠状动脉穿孔显著增加相关。全因死亡率在CTO RA组有非显著增加。
这项荟萃分析提供的证据表明，虽然CTO RA可能与冠状动脉穿孔风险较高相关，但与非CTO RA相比，包括MACE、TVR和全因死亡率在内的其他结果风险并无显著差异。需要更多研究来进一步了解这些关系，并优化接受CTO RA的CAD患者的治疗策略。
