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Outcomes of percutaneous intervention in in-stent versus de-novo chronic total occlusion: a meta-analysis

Tanveer Mir1, Waqas Ullah2, Yasar Sattar3

  • 1Internal Medicine, Wayne State University, Detroit Medical Center , Michigan, USA.

Expert Review of Cardiovascular Therapy
|August 27, 2020
PubMed

Insights

Percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO) may lead to more major adverse cardiac events (MACE) and myocardial infarction (MI) than for de-novo CTO. Procedural success and mortality rates were similar between the two groups.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Chronic total occlusion (CTO) signifies complete blockage in a coronary artery.
  • Outcomes of percutaneous coronary intervention (PCI) for in-stent CTO (IS-CTO) versus de-novo CTO require clarification.

Purpose of the Study:

  • To compare the outcomes of PCI in patients with IS-CTO versus de-novo CTO.
  • To evaluate major adverse cardiac events (MACE), cardiovascular mortality, myocardial infarction (MI), and procedural success.

Main Methods:

  • A comprehensive literature search identified relevant studies comparing IS-CTO and de-novo CTO.
  • Meta-analysis calculated odds ratios (OR) with 95% confidence intervals (CI) for primary and secondary endpoints.

Main Results:

  • The analysis included 3,681 patients across five studies (IS-CTO: 464; de-novo CTO: 3,217).
  • PCI for IS-CTO showed significantly higher odds of MACE (OR 2.21) and MI (OR 4.31) compared to de-novo CTO.
  • Cardiovascular mortality (OR 1.49) and procedural success (OR 1.11) rates were similar between the groups.

Conclusions:

  • PCI for IS-CTO may be associated with increased risks of MACE and MI compared to PCI for de-novo CTO.
  • Cardiovascular mortality and procedural failure rates do not differ significantly between IS-CTO and de-novo CTO PCI.
Abstract

Keywords:
In-stent CTOPCI outcomedenovo CTO

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