Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome

Int J Cardiol. 2015;187:90-6. doi: 10.1016/j.ijcard.2015.03.164. Epub 2015 Mar 17.

Abstract

Background: Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) may have a beneficial effect on survival through a better-preserved or improved LVEF. Current literature consists of small observational studies therefore we performed a weighted meta-analysis on the impact of revascularization of CTOs on left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and long-term mortality.

Methods: We conducted a meta-analysis evaluating LVEF before and after CTO PCI and long-term mortality. No language or time restrictions were applied. References from the identified articles and reviews were examined to find additional relevant manuscripts.

Results: Of the 812 citations, 34 studies performed between 1987-2014 in 2243 patients were eligible for LVEF and 27 studies performed between 1990-2013 in 11,085 patients with success and 4347 patients that failed CTO PCI were eligible for long-term mortality. After successful CTO PCI, LVEF increased with 4.44% (95% CI: 3.52-5.35, p<0.01) compared to baseline. In a small cohort of ~70 patients, no significant difference in LVEF was observed after non-successful CTO PCI or reocclusion. Additionally, 8 studies reported the change in left ventricular end-diastolic volume (LVEDV) in a total of 412 patients. LVEDV decreased with 6.14 ml/m(2) (95% CI: -9.31 to -2.97, p<0.01). Successful CTO PCI was also associated with reduced mortality in comparison with failed CTO PCI (OR: 0.52, 95% CI: 0.43-0.62, p-value<0.01).

Conclusions: The current meta-analysis revealed that successful recanalization of a CTO resulted in an overall improvement of 4.44% absolute LVEF points, reduced adverse remodeling and an improvement of survival (OR: 0.52).

Keywords: CTO; Chronic total occlusion; LVEDV; LVEF; Left ventricular function and mortality; Meta-analysis; Mortality; Percutaneous coronary intervention.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Chronic Disease
  • Coronary Occlusion / physiopathology
  • Coronary Occlusion / surgery*
  • Humans
  • Percutaneous Coronary Intervention / methods*
  • Risk Factors
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Function, Left / physiology*