5193Percutaneous coronary intervention provided better result than optimal medical therapy in patients with chronic total occlusion: a metanalysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Khanra ◽  
B Duggal ◽  
I Basu Ray ◽  
B Kumar ◽  
R Walia
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
All Cause Mortality

Abstract Background Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow up period, diverse clinical outcome, high drop-out and cross-over rate. Prematurely terminated DECISION CTO trail and the promising result of the most recent EUROCTO trial still left the quest unanswered. Previous metanalysis on the present context were restricted to studies with propensity-matched analysis only and did not incorporate the recent randomized trials. Purpose This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone. Methods The present protocol is registered in PROSPERO. PubMed, Embase and Cochrane databases were systematically reviewed. Fourteen studies meeting criteria were included in the meta-analysis. The Cochrane Risk of Bias scale was used to appraise the overall quality of the studies. Revman 5.3 software was used to analyse the data and random-effects model with inverse variance method was undertaken. R packages were used for assessment of bias and metaregression. Results Baseline parameters of both the groups were comparable. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and unplanned revascularization [Figure 1] were significantly lower in the PCI+OMT group. (RR: 0.77; 95% CI: 0.61 to 0.97; P≤0.ehz746.00521; I2=85%). High heterogeneity was partially (14%) explained by age factor. However study design, follow up duration, LVEF, presence of TVD did not attribute significantly to heterogeneity, in isolation or any combination in metregression model. All cause mortality and cardiac death [Figure 2, 3 respectively] were significantly lower in the PCI+OMT group (P=0.29, p=0.63, respectively). Myocardial infarction (P=0.25) and stroke rates (P=0.15) were lower in the PCI+OMT group, however they did not reach statistical significance. Unplanned revascularization (of any vessel) showed a higher trend in the PCI+OMT group, without reaching statistical significance (P=0.46, I2=88%). Conclusion PCI of CTO is rewarded with better long term outcome, in terms of MACE and all-cause mortality but limited to greater unplanned revascularization. Acknowledgement/Funding None

scholarly journals Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction

Heart ◽  
2018 ◽  
Vol 104 (17) ◽  
pp. 1432-1438 ◽  
Author(s):  
Joëlle Elias ◽  
Ivo M van Dongen ◽  
Truls Råmunddal ◽  
Peep Laanmets ◽  
Erlend Eriksen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Randomised Trial ◽  
Left Ventricular ◽  
Total Occlusion ◽  
St Elevation ◽  
One Year

BackgroundDuring primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.MethodsThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.ResultsThe median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).ConclusionsIn this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registrationEXPLORE trial number NTR1108 www.trialregister.nl.

scholarly journals Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yong Zhu ◽  
Shuai Meng ◽  
Maolin Chen ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Long Term Prognosis

Abstract Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.

scholarly journals A comparison of long-term clinical outcomes between PCI and medical therapy in patients with chronic total occlusion in non-Infarct-related arteries after AMI PCI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Q Qin ◽  
J Ma ◽  
J Ge
Keyword(s):  
Myocardial Infarction ◽  
Medical Therapy ◽  
Lower Incidence ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Long Term Outcomes ◽  
Total Occlusion ◽  
Kaplan Meier

Abstract Background Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients underwent successful percutaneous coronary intervention (s-PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI. Methods We retrospectively enrolled 330 patients (n=166 in s-PCI group and n=164 in MT group) with CTO in a non-IRA from a total of 4372 patients who underwent PCI after AMI from July 2011 to July 2019 in our center (Figure 1). Propensity matching (119 matched pairs) was used to adjust for baseline differences. Major adverse cardiovascular and cerebrovascular events (MACCEs) on follow-up were defined as the composite of cardiac death, all cause death, myocardial infarction (MI), stroke and any revascularization. Kaplan-Meier analysis were used to evaluate the long-term outcomes between s-PCI and MT group. Results The patients in MT group were older, more likely to be diagnosed as STEMI, had lower eGFR and higher peak troponin T level during AMI compared with s-PCI group. Furthermore, in MT group, the involvement of LAD as IRA (50.6% vs 38.6%, p=0.028) and LCX as CTO vessel (45.1% vs 27.1%, p=0.001) was more frequent than in s-PCI group, and thus the involvement of LAD as CTO vessel was less frequent (28.9% vs 39.8%, p&lt;0.001). During a median follow-up period of 946 days, patients in s-PCI group had significantly lower incidences of cardiac death (3.0% vs 10.4%, p=0.017) and all cause death (5.4% vs 14.0%, p=0.030) when compared with patients in MT group. Moreover, after PSM, patients in s-PCI group still showed lower incidence of cardiac death (2.5% vs 9.2%, p=0.04). The incidence of MI, stroke, revascularization and MACCE showed no significant difference between the two groups both before and after PSM. In multivariate analysis, age (HR 1.06, 95% CI 1.02–1.10, p=0.003) and LVEF&lt;50% (HR 4.71, 95% CI 1.72–12.90, p=0.003) showed significant correlation with long term cardiac death, however, successful CTO PCI showed borderline significance (HR 0.42, 95% CI 0.15–1.16, p=0.095). In subgroup analysis, Kaplan–Meier curve showed s-PCI group had a lower incidence of cardiac death compared with MT in patients with LVEF&lt;50% both before (p=0.011) and after PSM (p=0.045). However, no difference was observed between two groups in patients with LVEF≥50%. Conclusions In our center, s-PCI of CTO in non-IRA after AMI PCI showed better long-term cardiac survival as compared with MT. Moreover, patients with low LVEF may be benefit from CTO PCI in non-IRA. FUNDunding Acknowledgement Type of funding sources: None. Flow chart of the study Kaplan-Meier analysis between two groups

scholarly journals Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis

BMJ ◽  
2019 ◽  
pp. l2222 ◽  
Author(s):  
Shang-He-Lin Yin ◽  
Peng Xu ◽  
Bian Wang ◽  
Yao Lu ◽  
Qiao-Yu Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Efficacy And Safety ◽  
Short Term ◽  
All Cause Mortality ◽  
Standard Term

Abstract Objective To evaluate the efficacy and safety of standard term (12 months) or long term (>12 months) dual antiplatelet therapy (DAPT) versus short term (<6 months) DAPT after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Design Systematic review and network meta-analysis. Data sources Relevant studies published between June 1983 and April 2018 from Medline, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, ClinicalTrials.gov, and Clinicaltrialsregister.eu. Review methods Randomised controlled trials comparing two of the three durations of DAPT (short term, standard term, and long term) after PCI with DES were included. The primary study outcomes were cardiac or non-cardiac death, all cause mortality, myocardial infarction, stent thrombosis, and all bleeding events. Results 17 studies (n=46 864) were included. Compared with short term DAPT, network meta-analysis showed that long term DAPT resulted in higher rates of major bleeding (odds ratio 1.78, 95% confidence interval 1.27 to 2.49) and non-cardiac death (1.63, 1.03 to 2.59); standard term DAPT was associated with higher rates of any bleeding (1.39, 1.01 to 1.92). No noticeable difference was observed in other primary endpoints. The sensitivity analysis revealed that the risks of non-cardiac death and bleeding were further increased for ≥18 months of DAPT compared with short term or standard term DAPT. In the subgroup analysis, long term DAPT led to higher all cause mortality than short term DAPT in patients implanted with newer-generation DES (1.99, 1.04 to 3.81); short term DAPT presented similar efficacy and safety to standard term DAPT with acute coronary syndrome (ACS) presentation and newer-generation DES placement. The heterogeneity of pooled trials was low, providing more confidence in the interpretation of results. Conclusions In patients with all clinical presentations, compared with short term DAPT (clopidogrel), long term DAPT led to higher rates of major bleeding and non-cardiac death, and standard term DAPT was associated with an increased risk of any bleeding. For patients with ACS, short term DAPT presented similar efficacy and safety with standard term DAPT. For patients implanted with newer-generation DES, long term DAPT resulted in more all cause mortality than short term DAPT. Although the optimal duration of DAPT should take personal ischaemic and bleeding risks into account, this study suggested short term DAPT could be considered for most patients after PCI with DES, combining evidence from both direct and indirect comparisons. Systematic review registration PROSPERO CRD42018099519.

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