Angiographic Success and Procedural Complications in Patients Undergoing Percutaneous Coronary Chronic Total Occlusion Interventions: A Weighted Meta-Analysis of 18,061 Patients From 65 Studies

Study Questions:

What is the safety and outcome of chronic total occlusion (CTO) percutaneous coronary intervention (PCI)?

Methods:

The authors pooled a total of 65 studies to estimate success and complications of PCI of CTOs. Outcomes of interest included death, emergent coronary artery bypass graft surgery, stroke, myocardial infarction, perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury.

Results:

The study population included a total of 18,061 patients and 18,941 target CTO vessels. Angiographic success rate was 77%, death 0.2%, emergency emergent coronary artery bypass graft surgery 0.1%, stroke <0.01%, myocardial infarction 2.5%, Q-wave myocardial infarction 0.2%, coronary perforation 2.9% , tamponade 0.3%, and contrast nephropathy 3.8%. Compared with successful procedures, all complications were higher among those with unsuccessful procedures. Among 886 lesions treated with the retrograde approach, success rate was 79.8%, with no deaths and low rates of emergent coronary artery bypass graft surgery (0.17%) and tamponade (1.2%).

Conclusions:

The authors concluded that CTO PCI has a high success and a low complication rate.

Perspective:

This study provides an overview of CTO PCI outcomes and demonstrates a high procedural success and low complication rate. Most of the published data on CTO outcomes reflect the experience of highly experienced operators, and CTO PCI is best performed by those with experience in dealing with this lesion subset.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Myocardial Infarction, Stroke, Coronary Stenosis, Coronary Angiography, Health Resources, Thrombosis, Coronary Artery Bypass, Angioplasty, Patient Discharge, Stents, Percutaneous Coronary Intervention


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