Percutaneous coronary intervention versus medical therapy for chronic total occlusion of coronary arteries: A systematic review and meta-analysis

Li, Ka Hou Christien, Wong, Ka Hei Gabriel, Gong, Mengqi, Liu, Tong, Li, Guangping, Xia, Yunlong, Ho, Jeffery, Nombela-Franco, Luis, Sawant, Abhishek C, Eccleshall, Simon, Tse, Gary and Vassiliou, Vassilios S. ORCID: (2019) Percutaneous coronary intervention versus medical therapy for chronic total occlusion of coronary arteries: A systematic review and meta-analysis. Current Atherosclerosis Reports, 21 (10). ISSN 1523-3804

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PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT FINDINGS: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle-Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 12 Aug 2019 15:30
Last Modified: 19 May 2023 09:32
DOI: 10.1007/s11883-019-0804-8

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