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Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT...

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Autores principales: Li, Ka Hou Christien, Wong, Ka Hei Gabriel, Gong, Mengqi, Liu, Tong, Li, Guangping, Xia, Yunlong, Ho, Jeffery, Nombela-Franco, Luis, Sawant, Abhishek C., Eccleshall, Simon, Tse, Gary, Vassiliou, Vassilios S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689032/
https://www.ncbi.nlm.nih.gov/pubmed/31399762
http://dx.doi.org/10.1007/s11883-019-0804-8
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author Li, Ka Hou Christien
Wong, Ka Hei Gabriel
Gong, Mengqi
Liu, Tong
Li, Guangping
Xia, Yunlong
Ho, Jeffery
Nombela-Franco, Luis
Sawant, Abhishek C.
Eccleshall, Simon
Tse, Gary
Vassiliou, Vassilios S.
author_facet Li, Ka Hou Christien
Wong, Ka Hei Gabriel
Gong, Mengqi
Liu, Tong
Li, Guangping
Xia, Yunlong
Ho, Jeffery
Nombela-Franco, Luis
Sawant, Abhishek C.
Eccleshall, Simon
Tse, Gary
Vassiliou, Vassilios S.
author_sort Li, Ka Hou Christien
collection PubMed
description PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT FINDINGS: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. SUMMARY: PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle–Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I(2) index and Egger’s regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38–2.86), cardiac mortality (RR 2.36 (1.97–2.84)), and major adverse cardiac event (RR 1.25 (1.03–1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11883-019-0804-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-66890322019-08-23 Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis Li, Ka Hou Christien Wong, Ka Hei Gabriel Gong, Mengqi Liu, Tong Li, Guangping Xia, Yunlong Ho, Jeffery Nombela-Franco, Luis Sawant, Abhishek C. Eccleshall, Simon Tse, Gary Vassiliou, Vassilios S. Curr Atheroscler Rep Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor) PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT FINDINGS: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. SUMMARY: PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle–Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I(2) index and Egger’s regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38–2.86), cardiac mortality (RR 2.36 (1.97–2.84)), and major adverse cardiac event (RR 1.25 (1.03–1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11883-019-0804-8) contains supplementary material, which is available to authorized users. Springer US 2019-08-09 2019 /pmc/articles/PMC6689032/ /pubmed/31399762 http://dx.doi.org/10.1007/s11883-019-0804-8 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
Li, Ka Hou Christien
Wong, Ka Hei Gabriel
Gong, Mengqi
Liu, Tong
Li, Guangping
Xia, Yunlong
Ho, Jeffery
Nombela-Franco, Luis
Sawant, Abhishek C.
Eccleshall, Simon
Tse, Gary
Vassiliou, Vassilios S.
Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title_full Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title_fullStr Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title_full_unstemmed Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title_short Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
title_sort percutaneous coronary intervention versus medical therapy for chronic total occlusion of coronary arteries: a systematic review and meta-analysis
topic Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689032/
https://www.ncbi.nlm.nih.gov/pubmed/31399762
http://dx.doi.org/10.1007/s11883-019-0804-8
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