Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) is found to be associated with low complication rates and increasingly high success rates, according to a meta-analysis published on Jan. 23 in JACC Cardiovascular Interventions.

Additional Resources Full Study   2011 ACCF/AHA/SCAI Guideline for PCI  Study Shows Same-Day Discharge Reasonable for Selected PCI Patients (JACC CV Interv)

The meta-analysis included 65 studies conducted between 2000 and 2011, with a total of 18,061 patients with 18,941 target CTO vessels. The overall estimated angiographic success rate was 77 percent. The pooled major adverse cardiovascular event (MACE) rate was 3.1 percent. MIs (2.5 percent) accounted for most cardiovascular events. Perforation and contrast nephropathy were the most frequently observed complications (2.9 percent and 3.8 percent of patients, respectively), and the need for emergent coronary bypass surgery, stroke and radiation injury were reported infrequently (less than 0.1 percent of patients).

The study highlights the fact PCI for CTOs has been performed with increasing frequency over the last decade with increasingly successful results. "Our meta-analysis demonstrates that CTO PCI is currently performed with high and improving success, and low and decreasing complication rates, suggesting that CTO PCI carries a favorable risk/benefit ratio and supporting its increasing use for the treatment of this complex lesion and patient group," the authors said.

Meanwhile, the study comes on the heels of a separate meta-analysis, previously published in JACC CV Interventions, that found same-day discharge of patients following uncomplicated, elective PCI is a reasonable strategy for selected patients.

Keywords: Odds Ratio, Stroke, Heel, Risk Assessment, Coronary Artery Bypass, Radiation Injuries, Percutaneous Coronary Intervention

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