E-30 | Meta-Analysis of Successful Vs. Failed Chronic Total Occlusion Percutaneous Coronary Intervention

BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, the impact of CTO PCI on clinical events remains controversial.MethodsWe queried PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect to perform a systematic review and meta-analysis of studies that compared clinical outcomes of successful versus failed CTO PCI.ResultsOf the 24,685 identified publications, 34 observational studies were included in the meta-analysis. Overall, 38,048 patients underwent CTO PCI, 78% of the patients were men, median age was 63 years, 35% had previous myocardial infarction, 30% had previous PCI, and 27% were current smokers. Procedural success was 75%. The CTO target vessel was the left anterior descending artery in 39%, left circumflex in 21%, and the right coronary artery in 40%. During a median follow-up of 2.8 years, the incidence of all-cause mortality was 10%, cardiovascular death 4.5%, and coronary artery bypass grafting 7%. Compared with failed CTO PCI, successful CTO PCI was associated with significantly better clinical outcomes in observational studies: 48% lower incidence of all-cause mortality, 60% lower incidence of cardiovascular mortality, 54% lower incidence of major adverse clinical outcomes, and 34% lower incidence of myocardial infarction (Table).ConclusionsDisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. Rinfret: Prof Rinfret has been a consultant for Boston Scientific, Teleflex, Medtronic, Abbott, and Abiomed.: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; K. O. Tammam: Terumo: Consulting; M. N. Burke: MHI Ventures, stockholder. Egg Medical, stockholder: Consulting; S. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. N. A. Rafeh Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. P. Poommipanit Nothing to disclose. BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, the impact of CTO PCI on clinical events remains controversial. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can improve patient symptoms. However, the impact of CTO PCI on clinical events remains controversial. MethodsWe queried PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect to perform a systematic review and meta-analysis of studies that compared clinical outcomes of successful versus failed CTO PCI. We queried PubMed, Embase, Cochrane Library, Web of Science, and ScienceDirect to perform a systematic review and meta-analysis of studies that compared clinical outcomes of successful versus failed CTO PCI. ResultsOf the 24,685 identified publications, 34 observational studies were included in the meta-analysis. Overall, 38,048 patients underwent CTO PCI, 78% of the patients were men, median age was 63 years, 35% had previous myocardial infarction, 30% had previous PCI, and 27% were current smokers. Procedural success was 75%. The CTO target vessel was the left anterior descending artery in 39%, left circumflex in 21%, and the right coronary artery in 40%. During a median follow-up of 2.8 years, the incidence of all-cause mortality was 10%, cardiovascular death 4.5%, and coronary artery bypass grafting 7%. Compared with failed CTO PCI, successful CTO PCI was associated with significantly better clinical outcomes in observational studies: 48% lower incidence of all-cause mortality, 60% lower incidence of cardiovascular mortality, 54% lower incidence of major adverse clinical outcomes, and 34% lower incidence of myocardial infarction (Table). Of the 24,685 identified publications, 34 observational studies were included in the meta-analysis. Overall, 38,048 patients underwent CTO PCI, 78% of the patients were men, median age was 63 years, 35% had previous myocardial infarction, 30% had previous PCI, and 27% were current smokers. Procedural success was 75%. The CTO target vessel was the left anterior descending artery in 39%, left circumflex in 21%, and the right coronary artery in 40%. During a median follow-up of 2.8 years, the incidence of all-cause mortality was 10%, cardiovascular death 4.5%, and coronary artery bypass grafting 7%. Compared with failed CTO PCI, successful CTO PCI was associated with significantly better clinical outcomes in observational studies: 48% lower incidence of all-cause mortality, 60% lower incidence of cardiovascular mortality, 54% lower incidence of major adverse clinical outcomes, and 34% lower incidence of myocardial infarction (Table). Conclusions DisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. Rinfret: Prof Rinfret has been a consultant for Boston Scientific, Teleflex, Medtronic, Abbott, and Abiomed.: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; K. O. Tammam: Terumo: Consulting; M. N. Burke: MHI Ventures, stockholder. Egg Medical, stockholder: Consulting; S. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. N. A. Rafeh Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. P. Poommipanit Nothing to disclose. K. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; W. A. Jaber: consultant for Inari: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; S. Rinfret: Prof Rinfret has been a consultant for Boston Scientific, Teleflex, Medtronic, Abbott, and Abiomed.: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; S. A. Harding: Institutional research grants from Asahi Intecc and has received consulting/speakers fees from Boston Scientific, Abbott Vascular and Terumo: Consulting; A. Avran: Abbott Vascular, Boston Scientific, and Biosensor for teaching courses and proctoring: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; H. L. Kao: Speaker Board, Honorarium, Proctor, and research grant from Abbott Vascular, Asahi INTECC, Biotronik, Boston Scientific, Edwards Lifesciences, Elixir, Medtronic, Microport, Terumo: Consulting; L. Azzalini: Honoraria from Abbott Vascular, Guerbet, Terumo, and Sahajanand Medical Technologies and research support from ACIST Medical Systems, Guerbet, and Terumo.: Consulting; R. Garbo: Consultancy / Proctorship : Abbott, Boston scientific, IMDS, Philips Volcano, Kardia Asahi, Terumo,: Consulting; K. O. Tammam: Terumo: Consulting; M. N. Burke: MHI Ventures, stockholder. Egg Medical, stockholder: Consulting; S. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; K. J. Croce: Abbott: Advisory Board/Board Member and Consulting; Abiomed: Advisory Board/Board Member and Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cardiovascular Systems, Inc.: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; dyad: Ownership Interests: Stocks, Stock Options; takeda: Consulting; biotronik: Consulting; E. B. Wu: Abiomed, OrbusNeich, Asahi Intecc; has received consulting honoraria from Boston Scientific and Abbott Vascular; is a member of the board of directors for APCTO Club; and holds stock in Abbott Vascular: Consulting; E. Tsuchikane: Consultants for Asahi Intecc, Boston Scientific and Kanaka: Consulting; C. Di Mario: Research grants from Abbott, Boston Scientific, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Philips-Volcano: Consulting; A. Gagnor: Consultant Boston Scientific, Terumo: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; B. Simsek Nothing to disclose. S. Kostantinis Nothing to disclose. J. Karacsonyi Nothing to disclose. K. Mashayekhi Nothing to disclose. G. S. Werner Nothing to disclose. M. McEntegart Nothing to disclose. S. W. Lee Nothing to disclose. B. Xu Nothing to disclose. G. Sianos Nothing to disclose. M. Yamane Nothing to disclose. A. Milkas Nothing to disclose. N. A. Rafeh Nothing to disclose. I. Nikolakopoulos Nothing to disclose. E. Vemmou Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. A. R. Galassi Prof Nothing to disclose. P. Knaapen Nothing to disclose. Y. Jang Nothing to disclose. B. K. Kim Nothing to disclose. P. Poommipanit Nothing to disclose.