Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion Compared to Optimal Medical Therapy: A systematic review and meta-analysis AHA Conference Repository

American Heart Association

Final ID: Sa3055

Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion Compared to Optimal Medical Therapy: A systematic review and meta-analysis

Abstract Body (Do not enter title and authors here):
Introduction:
Chronic total occlusion (CTO) is commonly encountered in patients with coronary artery disease and is associated with adverse outcomes, including increased short- and long-term mortality. While percutaneous coronary intervention (PCI) has shown potential clinical benefits in CTO patients, its comparative effectiveness against optimal medical therapy (OMT) remains debated. This meta-analysis aims to evaluate the impact of CTO-PCI versus OMT on key cardiovascular outcomes.

Methods:
We conducted a comprehensive search of Pubmed, Scopus, Web of science and Cochrane. We assessed outcomes including all-cause mortality, cardiac death, myocardial reinfarction, major adverse cardiac events (MACE), stroke, and repeat revascularization. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical significance was defined as p<0.05.

Results:
25 studies with a total of 22102 patients were included. Compared to OMT alone, CTO-PCI was associated with a significant reduction in the overall all-cause mortality (RR: 0.66; 95% CI: 0.53–0.82; p=0.0002), cardiovascular mortality (RR: 0.65; 95% CI: 0.52–0.82; p=0.0003) and MACE (RR: 0.84; 95% CI: 0.71–0.98; p=0.03). No statistically significant differences were observed between CTO-PCI and OMT in rates of Stroke (RR: 1.01; 95% CI: 0.68–1.50; p=0.96), Subsequent PCI/CABG (revascularization) (RR: 1.01; 95% CI: 0.78–1.29; p=0.97) or Heart Failure Hospitalization (RR: 0.77; 95% CI: 0.37–1.59; p=0.48)

Conclusion:
This is the largest and most updated systematic review meta analysis for CTO-PCI vs OMT. Our findings show that CTO-PCI is associated with significantly lower all-cause and cardiovascular mortality compared to OMT. However, no significant differences were observed between the two strategies in the incidence of stroke, need for subsequent revascularization (PCI/CABG), or heart failure hospitalization.

Kholeif, Zeyad ( Baptist Hospital of SouthEast Texas , Beaumont , Texas , United States )
Mohamed, Ahmed ( Faculty of Medicine, Tanta University , Tanta , Egypt )
Elnashar, Mohab ( UAMS , Little Rock , Arkansas , United States )
Samman Tahhan, Imad ( Medical University of South Carolin , Charleston , South Carolina , United States )
Elnady, Mohamed ( Faculty of medicine Kafer El Sheikh , Kafer el sheikh , Egypt )
Rashwan, Rana ( Mayo Clinic , Rochester , Minnesota , United States )
Ali, Khaled ( Rosalind Franklin University , North Chicago , Illinois , United States )
Shaik, Mohammed Ashwaq Hussain ( ACSR GOVT medical College , Nellore , India )
Elsayed, Rana ( Faculty of Medicine, Cairo University , Cairo , Egypt )
Elnaggar, Ahmed ( Faculty of Medicine, Cairo University , Cairo , Egypt )
Diaa, Ahmed ( Faculty of Medicine, Al-azhar University , Cairo , Egypt )
Elalfy, Aya ( Mayo Clinic , Jacksonville , Florida , United States )
Hemida, Mohamed Fawzi ( Alexandria Faculty of Medicine , Alexandria , Egypt )
Gadelmawla, Ahmed Farid ( Faculty of Medicine, Menoufia University , Menoufia , Egypt )
Elkasaby, Hamza ( Faculty of Medicine, Newgiza University , Cairo , Egypt )

Author Disclosures:

Zeyad Kholeif: