A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention

Bahadir Simsek; Spyridon Kostantinis; Judit Karacsonyi; Khaldoon Alaswad; Michael Megaly; Dimitrios Karmpaliotis; Amirali Masoumi; Wissam A. Jaber; William Nicholson; Stephane Rinfret; Kambis Mashayekhi; Gerald S. Werner; Margaret McEntegart; Seung Whan Lee; Jaikirshan J. Khatri; Scott A. Harding; Alexandre Avran; Farouc A. Jaffer; Darshan Doshi; Hsien Li Kao; Georgios Sianos; Masahisa Yamane; Anastasios Milkas; Lorenzo Azzalini; Roberto Garbo; Khalid Tammam; Nidal Abi Rafeh; Ilias Nikolakopoulos; Evangelia Vemmou; Bavana V. Rangan; M. Nicholas Burke; Santiago Garcia; Kevin J. Croce; Eugene B. Wu; Etsuo Tsuchikane; Carlo Di Mario; Alfredo R. Galassi; Andrea Gagnor; Paul Knaapen; Yangsoo Jang; Byeong Keuk Kim; Paul B. Poommipanit; Emmanouil S. Brilakis

A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Michael Megaly, Dimitrios Karmpaliotis, Amirali Masoumi, Wissam A. Jaber, William Nicholson, Stephane Rinfret, Kambis Mashayekhi, Gerald S. Werner, Margaret McEntegart, Seung Whan Lee, Jaikirshan J. Khatri, Scott A. Harding, Alexandre Avran, Farouc A. Jaffer, Darshan Doshi, Hsien Li KaoGeorgios Sianos, Masahisa Yamane, Anastasios Milkas, Lorenzo Azzalini, Roberto Garbo, Khalid Tammam, Nidal Abi Rafeh, Ilias Nikolakopoulos, Evangelia Vemmou, Bavana V. Rangan, M. Nicholas Burke, Santiago Garcia, Kevin J. Croce, Eugene B. Wu, Etsuo Tsuchikane, Carlo Di Mario, Alfredo R. Galassi, Andrea Gagnor, Paul Knaapen, Yangsoo Jang, Byeong Keuk Kim, Paul B. Poommipanit, Emmanouil S. Brilakis

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Objectives. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes. Methods. 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. Results. 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. Conclusions. 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.

Original language	English
Pages (from-to)	E763-E775
Journal	Journal of Invasive Cardiology
Volume	34
Issue number	11
State	Published - Nov 2022
Externally published	Yes

Keywords

Chronic total occlusion
Clinical outcomes
Meta-Analysis
Percutaneous coronary intervention
Systematic review

Cite this

Simsek, B., Kostantinis, S., Karacsonyi, J., Alaswad, K., Megaly, M., Karmpaliotis, D., Masoumi, A., Jaber, W. A., Nicholson, W., Rinfret, S., Mashayekhi, K., Werner, G. S., McEntegart, M., Lee, S. W., Khatri, J. J., Harding, S. A., Avran, A., Jaffer, F. A., Doshi, D., ... Brilakis, E. S. (2022). A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention. Journal of Invasive Cardiology, 34(11), E763-E775.

@article{7ba919177e444661a3b90c7b4bc5389f,

title = "A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention",

abstract = "Objectives. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes. Methods. 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. Results. 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. Conclusions. 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.",

keywords = "Chronic total occlusion, Clinical outcomes, Meta-Analysis, Percutaneous coronary intervention, Systematic review",

author = "Bahadir Simsek and Spyridon Kostantinis and Judit Karacsonyi and Khaldoon Alaswad and Michael Megaly and Dimitrios Karmpaliotis and Amirali Masoumi and Jaber, {Wissam A.} and William Nicholson and Stephane Rinfret and Kambis Mashayekhi and Werner, {Gerald S.} and Margaret McEntegart and Lee, {Seung Whan} and Khatri, {Jaikirshan J.} and Harding, {Scott A.} and Alexandre Avran and Jaffer, {Farouc A.} and Darshan Doshi and Kao, {Hsien Li} and Georgios Sianos and Masahisa Yamane and Anastasios Milkas and Lorenzo Azzalini and Roberto Garbo and Khalid Tammam and Rafeh, {Nidal Abi} and Ilias Nikolakopoulos and Evangelia Vemmou and Rangan, {Bavana V.} and {Nicholas Burke}, M. and Santiago Garcia and Croce, {Kevin J.} and Wu, {Eugene B.} and Etsuo Tsuchikane and {Di Mario}, Carlo and Galassi, {Alfredo R.} and Andrea Gagnor and Paul Knaapen and Yangsoo Jang and Kim, {Byeong Keuk} and Poommipanit, {Paul B.} and Brilakis, {Emmanouil S.}",

note = "Publisher Copyright: {\textcopyright} 2022 HMP Global.",

year = "2022",

month = nov,

language = "English",

volume = "34",

pages = "E763--E775",

journal = "Journal of Invasive Cardiology",

issn = "1042-3931",

publisher = "Cliggott Publishing Co.",

number = "11",

}

Simsek, B, Kostantinis, S, Karacsonyi, J, Alaswad, K, Megaly, M, Karmpaliotis, D, Masoumi, A, Jaber, WA, Nicholson, W, Rinfret, S, Mashayekhi, K, Werner, GS, McEntegart, M, Lee, SW, Khatri, JJ, Harding, SA, Avran, A, Jaffer, FA, Doshi, D, Kao, HL, Sianos, G, Yamane, M, Milkas, A, Azzalini, L, Garbo, R, Tammam, K, Rafeh, NA, Nikolakopoulos, I, Vemmou, E, Rangan, BV, Nicholas Burke, M, Garcia, S, Croce, KJ, Wu, EB, Tsuchikane, E, Di Mario, C, Galassi, AR, Gagnor, A, Knaapen, P, Jang, Y, Kim, BK, Poommipanit, PB & Brilakis, ES 2022, 'A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention', Journal of Invasive Cardiology, vol. 34, no. 11, pp. E763-E775.

TY - JOUR

T1 - A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention

AU - Simsek, Bahadir

AU - Kostantinis, Spyridon

AU - Karacsonyi, Judit

AU - Alaswad, Khaldoon

AU - Megaly, Michael

AU - Karmpaliotis, Dimitrios

AU - Masoumi, Amirali

AU - Jaber, Wissam A.

AU - Nicholson, William

AU - Rinfret, Stephane

AU - Mashayekhi, Kambis

AU - Werner, Gerald S.

AU - McEntegart, Margaret

AU - Lee, Seung Whan

AU - Khatri, Jaikirshan J.

AU - Harding, Scott A.

AU - Avran, Alexandre

AU - Jaffer, Farouc A.

AU - Doshi, Darshan

AU - Kao, Hsien Li

AU - Sianos, Georgios

AU - Yamane, Masahisa

AU - Milkas, Anastasios

AU - Azzalini, Lorenzo

AU - Garbo, Roberto

AU - Tammam, Khalid

AU - Rafeh, Nidal Abi

AU - Nikolakopoulos, Ilias

AU - Vemmou, Evangelia

AU - Rangan, Bavana V.

AU - Nicholas Burke, M.

AU - Garcia, Santiago

AU - Croce, Kevin J.

AU - Wu, Eugene B.

AU - Tsuchikane, Etsuo

AU - Di Mario, Carlo

AU - Galassi, Alfredo R.

AU - Gagnor, Andrea

AU - Knaapen, Paul

AU - Jang, Yangsoo

AU - Kim, Byeong Keuk

AU - Poommipanit, Paul B.

AU - Brilakis, Emmanouil S.

PY - 2022/11

Y1 - 2022/11

N2 - Objectives. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes. Methods. 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. Results. 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. Conclusions. 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.

AB - Objectives. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms, but it remains controversial whether it impacts subsequent clinical outcomes. Methods. 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. Results. 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. Conclusions. 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.

KW - Chronic total occlusion

KW - Clinical outcomes

KW - Meta-Analysis

KW - Percutaneous coronary intervention

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85146063963&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:85146063963

SN - 1042-3931

VL - 34

SP - E763-E775

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

IS - 11

ER -

A systematic review and meta-Analysis of clinical outcomes of patients undergoing chronic total occlusion percutaneous coronary intervention

Abstract

Keywords

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