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Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A

Mario Iannaccone1, Fabrizio D'ascenzo2, Fabio Piazza1

  • 1SS. Annunziata Hospital, ASL CN 1, Savigliano, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 15, 2018
PubMed

Insights

Percutaneous coronary intervention for coronary chronic total occlusions (CTO-PCI) showed similar major adverse cardiac events compared to optimal medical therapy (OMT). However, CTO-PCI may reduce cardiovascular death, particularly in propensity score-matched studies.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Optimal management for coronary chronic total occlusions (CTO) is debated.
  • Percutaneous coronary intervention (CTO-PCI) and optimal medical therapy (OMT) are primary treatment strategies.

Purpose of the Study:

  • To compare the efficacy and safety of CTO-PCI versus OMT.
  • To evaluate outcomes including major adverse cardiac events (MACE) and cardiovascular death.

Main Methods:

  • Meta-analysis of randomized controlled trials (RCTs) and propensity score-matched (PSM) observational studies.
  • Literature search across MEDLINE, EMBASE, and Web of Science.
  • Primary endpoint: MACE (composite of cardiovascular death, acute coronary syndrome, repeat PCI).

Main Results:

  • Eight studies (4 RCTs, 4 PSMs) with 3,971 patients (2,050 CTO-PCI, 1,921 OMT) and 3-year follow-up included.
  • No significant differences in overall MACE, repeat PCI, or acute myocardial infarction (AMI).
  • CTO-PCI showed reduced cardiovascular death in PSM studies (OR 0.52, P < 0.01).

Conclusions:

  • CTO-PCI is associated with similar MACE rates compared to OMT.
  • CTO-PCI may offer a survival benefit regarding cardiovascular death, primarily suggested by PSM data.
Abstract

Keywords:
chronic total occlusionoptimal medical therapypercutaneous coronary intervention

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