Clinical InvestigationInterventional CardiologyEffectiveness of recanalization of chronic total occlusions: A systematic review and meta-analysis
Section snippets
Methods
We performed a systematic review and meta-analysis in accordance with the standards set forth by the Quality of Reporting of Meta-analyses (QUOROM) statement.5 We searched PubMed, EMBASE, Web of Science, and the Cochrane Library (up to January 30, 2009). We used the following keywords: “chronic total occlusion,” “percutaneous coronary intervention,” “angioplasty,” and “stent.” We limited our search to the English and French language. In addition, we hand-searched references of retrieved
Results
We did not identify any randomized controlled trial (RCT) or observational study comparing CTO recanalization to a planned medical management strategy. We identified 13 observational studies comparing successful CTO recanalization to a strategy of medical management as a result of attempted but failed CTO recanalization.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18Figure 1 shows the flow diagram leading to our article selection. Included studies encompassed 7,288 patients treated between 1979
Discussion
Despite increasing interest in the use of PCI for CTO, we found no randomized or observational studies directly comparing recanalization to medical management. Therefore, the current meta-analysis applies only to clinical outcomes after attempted recanalization. In this selected population, we found that successful CTO recanalization was associated with a 44% reduction in mortality, a 78% reduction in subsequent CABG, and a 55% reduction in residual/recurrent angina. Successful recanalization
Conclusion
In the highly selected population of patients who underwent successful recanalization of a CTO, long-term outcomes appear to be improved. Our findings support the evidence suggesting a survival advantage associated with successful versus failed attempt of CTO recanalization as far as it is possible short of an RCT. However, based on the observational nature of the evidence, randomized control trials comparing recanalization to a planed medical management are needed to confirm these findings.
Acknowledgement
Dr Rinfret is a junior clinician-scientist supported by the Fonds de recherche en santé du Québec (FRSQ).
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Conflict of interest/disclosure: None.