TY - JOUR
T1 - Staged percutaneous intervention for concurrent chronic total occlusions in patients with st-segment–elevation myocardial infarction
T2 - A systematic review and meta-analysis
AU - Villablanca, Pedro A.
AU - Olmedo, Wilman
AU - Weinreich, Michael
AU - Gupta, Tanush
AU - Mohananey, Divyanshu
AU - Albuquerque, Felipe N.
AU - Kassas, Ibrahim
AU - Briceño, David
AU - Sanina, Cristina
AU - Brevik, Thomas A.
AU - Ong, Emily
AU - Ramakrishna, Harish
AU - Attubato, Michael
AU - Menegus, Mark
AU - Wiley, Jose
AU - Kalra, Ankur
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/4/17
Y1 - 2018/4/17
N2 - Background-—Studies have shown that chronic total occlusion (CTO) in a noninfarct-related artery in patients with ST-segment– elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct-related artery CTO in patients with ST-segment–elevation myocardial infarction translates to improved outcomes. We performed a meta-analysis to compare outcomes between patients presenting with ST-segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct-related artery CTO versus those who did not. Method and Results-—We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all-cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all-cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33). Conclusions-—In this meta-analysis, CTO percutaneous coronary intervention of the noninfarct-related artery in patients presenting with ST-segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
AB - Background-—Studies have shown that chronic total occlusion (CTO) in a noninfarct-related artery in patients with ST-segment– elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct-related artery CTO in patients with ST-segment–elevation myocardial infarction translates to improved outcomes. We performed a meta-analysis to compare outcomes between patients presenting with ST-segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct-related artery CTO versus those who did not. Method and Results-—We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all-cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all-cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33). Conclusions-—In this meta-analysis, CTO percutaneous coronary intervention of the noninfarct-related artery in patients presenting with ST-segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
KW - Chronic total occlusion
KW - Meta-analysis
KW - Percutaneous coronary intervention
KW - ST-segment–elevation myocardial infarction
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UR - http://www.scopus.com/inward/citedby.url?scp=85048016379&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.008415
DO - 10.1161/JAHA.117.008415
M3 - Article
C2 - 29654206
AN - SCOPUS:85048016379
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 8
M1 - e008415
ER -