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Successful CTO PCI associated with positive outcomes
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Successful chronic total occlusion PCI was associated with a nearly 50% reduction in mortality compared with unsuccessful attempts at the same procedure, according to results of a recent meta-analysis.
The researchers evaluated 25 observational studies conducted between 1990 and 2014 to determine long-term outcomes of successful CTO PCI vs. failed CTO PCI. The weighted analysis included 29,315 procedures (20,778 successful) performed on 28,486 patients.
Data for mortality, subsequent CABG, MI, MACE, angina pectoris, stroke and target vessel revascularization were compared between successful and unsuccessful PCI procedures. Weighted mean follow-up was 3.11 years.
Procedural success occurred in 71% (range, 51-87) of cases, Georgios E. Christakopoulos, MD, and colleagues reported.
Georgios E. Christakopoulos
Compared with unsuccessful CTO PCI, successful interventions yielded a lower mortality rate (OR = 0.52; 95% CI, 0.43-0.63) and fewer strokes (OR = 0.72; 95% CI, 0.6-0.88), Christakopoulos, from the department of cardiovascular diseases at the Veterans Administration North Texas Healthcare System and the University of Texas Southwestern Medical Center, Dallas, and colleagues found.
Other outcomes improved by successful CTO PCI compared with unsuccessful were residual angina (OR = 0.38; 95% CI, 0.24-0.6), need for subsequent CABG (OR = 0.18; 95% CI, 0.14-0.22) and MACE (OR = 0.59; 95% CI, 0.44-0.79).
TVR, however, was statistically similar in the successful and unsuccessful CTO PCI groups (OR = 0.66; 95% CI, 0.36-1.23), as was MI (OR = 0.73; 95% CI, 0.52-1.03). Only five studies included reports of TVR.
No differences were reported for patients undergoing balloon angioplasty or intervention with bare-metal stents or drug-eluting stents. Eleven of the studies in the analysis were conducted using only stents, whereas six of the studies did not use any stents. The researchers evaluated all-cause mortality in both the stent (OR = 0.44; 95% CI, 0.28-0.68) and non-stent groups (OR = 0.5; 95% CI, 0.28-0.89). DES and non-DES yielded similar all-cause mortality rates.
“Potential explanations for the better outcomes observed among successful CTO PCI cases include a beneficial effect of CTO recanalization, a harmful effect of CTO PCI failure, or higher baseline clinical risk among patients in whom CTO PCI failed (ie, confounding),” the researchers concluded. “CTO recanalization could reduce the risk for arrhythmias and potentially improve outcomes if a patient develops an [ACS].” – by Rob Volansky
Disclosure: Christakopoulos reports no relevant financial disclosures. See the full study for a list of all other researchers’ relevant financial disclosures.
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