Outcomes of Percutaneous Coronary Intervention Versus Optimal Medical Treatment for Chronic Total Occlusion: A Comprehensive Meta-analysis

Abstract

The presence of concurrent chronic total occlusion (CTO) is a strong predictor for both short-term and long-term mortality. Successful percutaneous coronary intervention (PCI) of CTO has been associated with clinical benefit. We sought to perform a meta-analysis comparing CTO-PCI versus optimal medical therapy. PubMed, ClinicalTrials.gov, Google scholar and the Cochrane Central Register of Controlled Trials were searched for studies published from 2006 to 2019. A total of 16 studies, with 11,314 patients were included. We analyzed data on mortality, cardiac deaths, myocardial re-infarction, major adverse cardiac events, stroke, and repeat CTO-PCI using random-effects models. The odds ratios (OR) with 95% confidence interval (CI) were computed and P < 0.05 was considered as a level of significance. Compared with medical therapy alone, CTO-PCI was associated with lower mortality (OR: 0.45, CI: 0.32-0.63, P < 0.00001) and cardiac deaths (OR: 0.58, CI: 0.38-0.89, P = 0.01). These results were primarily driven by observational studies with no difference observed in randomized controlled trials. There was no significant difference in the incidence of major adverse cardiac events (OR: 0.71, CI: 0.48-1.05, P = 0.54), myocardial re-infarction (OR: 0.71, CI: 0.48-1.05, P = 0.54), stroke (OR: 0.61, CI: 0.32-1.17, P = 0.14, and repeat PCI (OR: 1.28, CI: 0.91-1.78, P = 0.16). This meta-analysis shows lower long-term mortality and cardiac deaths in CTO-PCI group as compared to OMT driven by observational studies with no difference observed in randomized controlled trials. Further randomized trials are needed to confirm these findings and evaluate long term results.