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Comparison of Clinical Outcomes Between Antegrade and Retrograde Techniques for Chronic Total Occlusion
Godfrey Tabowei1, Monica Kontor2, Mandeep Kaur3
1Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA.
Insights
The antegrade approach for chronic total occlusion percutaneous coronary intervention (CTO-PCI) offers higher technical and procedural success rates. This method also demonstrates reduced risks of major adverse cardiac events compared to the retrograde technique.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Technology
Background:
- Chronic total occlusions (CTOs) pose significant challenges in interventional cardiology.
- Percutaneous coronary intervention (PCI) is a key treatment modality for CTOs.
- Comparing different PCI techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of antegrade versus retrograde techniques in CTO-PCI.
- To evaluate procedural success, technical success, and adverse cardiac events.
- To provide evidence-based recommendations for CTO-PCI strategies.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive search of electronic databases up to June 20, 2024.
- Inclusion of seventeen studies comparing antegrade and retrograde CTO-PCI methods.
Main Results:
- The antegrade approach demonstrated a 5% higher likelihood of technical success (OR: 1.05) and 14% higher odds of procedural success (OR: 1.14).
- The antegrade group showed significantly lower risks of major adverse cardiac events (MACE), all-cause mortality, and myocardial infarction (RR: 0.40).
- The retrograde technique remains valuable for complex lesions and patients with comorbidities.
Conclusions:
- The antegrade approach is associated with superior success rates and improved safety profiles in CTO-PCI.
- The retrograde technique is essential for managing complex CTO cases.
- Further research may refine optimal strategy selection based on lesion complexity and patient factors.
Abstract:
Chronic total occlusions (CTOs) present significant challenges in interventional cardiology. This meta-analysis aims to compare the efficacy and safety of retrograde versus antegrade techniques in CTO percutaneous coronary intervention (PCI). A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases were searched through June 20, 2024. Studies comparing outcomes between antegrade and retrograde methods for CTO-PCI were included. Primary outcomes were procedural and technical success. Secondary outcomes included major adverse cardiac events (MACE), all-cause mortality, and myocardial infarction. The final analysis included seventeen studies. The antegrade approach showed a 5% higher likelihood of technical success (OR: 1.05, 95% CI: 1.02-1.09) and 14% higher odds of procedural success (OR: 1.14, 95% CI: 1.10-1.19) compared to the retrograde approach. The antegrade group also demonstrated lower risks of MACE, all-cause mortality, and myocardial infarction (RR: 0.40, 95% CI: 0.26-0.63). This meta-analysis suggests that the antegrade approach in CTO-PCI is associated with higher success rates and lower risks of adverse outcomes compared to the retrograde approach. However, the retrograde technique remains crucial for complex lesions and patients with multiple comorbidities.
