Document Detail

Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies.
MedLine Citation:
PMID:  23352817     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
BACKGROUND: The safety profile of CTO PCI has received limited study.
METHODS: We conducted a meta-analysis of 65 studies published between 2000 and 2011 reporting procedural complications of CTO PCI. Data on the frequency of death, emergent coronary artery bypass graft surgery, stroke, myocardial infarction, perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected.
RESULTS: A total of 65 studies with 18,061 patients and 18,941 target CTO vessels were included. Pooled estimates of outcomes were as follows: angiographic success 77% (95% confidence interval [CI]: 74.3% to 79.6%); death 0.2% (95% CI: 0.1% to 0.3%); emergent coronary artery bypass graft surgery 0.1% (95% CI: 0.0% to 0.2%); stroke <0.01% (95% CI: 0.0% to 0.1%); myocardial infarction 2.5% (95% CI: 1.9% to 3.0%); Q-wave myocardial infarction 0.2% (95% CI: 0.1% to 0.3%); coronary perforation 2.9% (95% CI: 2.2% to 3.6%); tamponade 0.3% (95% CI: 0.2% to 0.5%); and contrast nephropathy 3.8% (95% CI: 2.4% to 5.3%). Compared with successful procedures, unsuccessful procedures had higher rates of death (0.42% vs. 1.54%, p < 0.0001), perforation (3.65% vs. 10.70%, p < 0.0001), and tamponade (0% vs. 1.65%, p < 0.0001). Among 886 lesions treated with the retrograde approach, success rate was 79.8% with no deaths and low rates of emergent coronary artery bypass graft surgery (0.17%) and tamponade (1.2%).
CONCLUSIONS: CTO PCI carries low risk for procedural complications despite high success rates.
Vishal G Patel; Kimberly M Brayton; Aracely Tamayo; Owen Mogabgab; Tesfaldet T Michael; Nathan Lo; Mohammed Alomar; Deborah Shorrock; Daisha Cipher; Shuaib Abdullah; Subhash Banerjee; Emmanouil S Brilakis
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-23
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  6     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-22     Completed Date:  2013-08-12     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  128-36     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cardiac Tamponade / etiology,  radiography,  therapy
Chi-Square Distribution
Chronic Disease
Contrast Media / adverse effects,  diagnostic use
Coronary Angiography* / adverse effects
Coronary Artery Bypass
Coronary Occlusion / mortality,  radiography,  therapy*
Coronary Vessels / injuries,  radiography*,  surgery
Heart Injuries / etiology,  radiography,  therapy
Kidney Diseases / chemically induced
Logistic Models
Middle Aged
Myocardial Infarction / etiology,  radiography,  therapy
Percutaneous Coronary Intervention / adverse effects*,  mortality
Predictive Value of Tests
Radiation Injuries / etiology
Risk Assessment
Risk Factors
Stroke / etiology,  radiography,  therapy
Time Factors
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Contrast Media
Comment In:
JACC Cardiovasc Interv. 2013 Feb;6(2):137-8   [PMID:  23352819 ]

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