Objectives The aim of this meta-analysis is to perform an evaluation on short-term and longterm effectiveness of PCI for CTO recanalisation.
Methods We conducted with a search of PUBMED, ELSEVIER, and CLINICAL. COM from January 2000 until July 2012. Either observational studies or randomised clinical trials which compared PCI treatment of CTO recanalisation to medical management were included. Two investigators independently extracted data in standard forms. The endpoints were analysed by using pooled estimates for death, myocardial infarction (MI), CABG, angina symptoms, repeat revascularisation, and the major adverse cardiac event (MACE).
Results Sixteen observational studies comparing outcomes after failed vs. successful CTO recanalisation with PCI were found. These studies enrolling 10,256 patients observed at an average follow-up period of 5 years. Successful CTO recanalisation group significantly reduced the rates of all-cause death (OR-0.47, 95% CI 0.39-0.56, P < 0.00001), cardiac death (OR-0.43, 95% CI 0.31-0.62, P < 0.00001), MACE (OR-0.49, 95% CI 0.35-0.67, P < 0.0001), MI (OR-0.73, 95% CI 0.60-0.90, P = 0.003), and subsequence coronary artery bypass surgery (OR-0.19, 95% CI 0.15-0.23, P < 0.00001), as well as in long-term repeat revascularisation (OR-0.60, 95% CI 0.37-0.96, P = 0.03). In addition, successful CTO improved quality of life (P = 0.0001), reduced both MACE (P < 0.00001) and mortality (P = 0.004) in patients with multivessel disease, but only resulted in lower rate of death in patients with single vessel disease (P = 0.02).
Conclusions Base on this meta-analysis, PCI should be considered a efficacious option for the patients with CTO lesions and the future randomised trials should confirmed these results.