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Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta‐analysis of randomized controlled trials and propensity score adjusted studies
Author(s) -
Iannaccone Mario,
D'ascenzo Fabrizio,
Piazza Fabio,
De Benedictis Michele,
Doronzo Baldassarre,
Behnes Michael,
Garbo Roberto,
Mashayekhi Kambis
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28037
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , mace , randomized controlled trial , clinical endpoint , cardiology , acute coronary syndrome , propensity score matching , revascularization , meta analysis , myocardial infarction
The optimal management of patients with coronary chronic total occlusions (CTO) remains controversial. This meta‐analysis aims to compare percutaneous coronary intervention of CTO (CTO‐PCI) versus optimal medical therapy (OMT) in CTO patients. Methods A literature search with highly specific terms was conducted using MEDLINE, EMBASE, and Web of Science to identify most relevant randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) evaluating differences in between CTO‐PCI versus OMT. The primary endpoint was the incidence of major adverse cardiac events (MACEs, composite of cardiovascular death, acute coronary syndrome, and repeat PCI, re‐PCI) while its single components were defined as secondary endpoints. Results A total of eight studies was included, four RCTs and four PSMs. 3,971 patients were included in the analysis (2,050 CTO‐PCI versus 1,921 OMT) with a mean follow‐up of 3 years. No significant differences were found regarding overall MACE, re‐PCI and AMI. Regarding CV‐death, CTO‐PCI was associated with a better outcome compared with OMT driven by PSMs (OR 0.52, 0.0.81, P < 0.01). Conclusions As compared to OMT, CTO‐PCI was associated with similar MACE rate; however, CTO‐PCI may be associated with reduced CV death, mainly due to PSMs effect.