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Attenuated plaque detected by intravascular ultrasound: clinical, angiographic, and morphologic features and post-percutaneous coronary intervention complications in patients with acute coronary syndromes Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial Association of Prior Left Ventricular Ejection Fraction With Clinical Outcomes in Patients With Heart Failure With Midrange Ejection Fraction Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial Circadian Cadence and NR1D1 Tune Cardiovascular Disease DAPT, Our Genome and Clopidogrel Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association Timing of intervention in asymptomatic patients with valvular heart disease
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Review Article2019 May 1;93(6):E320-E325.

JOURNAL：Catheter Cardiovasc Interv. Article Link

Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta-analysis of randomized controlled trials and propensity score adjusted studies

Iannaccone M, D'ascenzo F, Piazza F et al. Keywords: CTO; OMT; meta-analysis

ABSTRACT

INTRODUCTION - The optimal management of patients with coronary chronic total occlusions (CTO) remains controversial. This meta-analysis aims to compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal medical therapy (OMT) in CTO patients.


METHODS - A literature search with highly specific terms was conducted using MEDLINE, EMBASE, and Web of Science to identify most relevant randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) evaluating differences in between CTO-PCI versus OMT. The primary endpoint was the incidence of major adverse cardiac events (MACEs, composite of cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI) while its single components were defined as secondary endpoints.


RESULTS - A total of eight studies was included, four RCTs and four PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus 1,921 OMT) with a mean follow-up of 3 years. No significant differences were found regarding overall MACE, re-PCI and AMI. Regarding CV-death, CTO-PCI was associated with a better outcome compared with OMT driven by PSMs (OR 0.52, 0.0.81, P < 0.01).


CONCLUSIONS - As compared to OMT, CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be associated with reduced CV death, mainly due to PSMs effect.

© 2018 Wiley Periodicals, Inc.

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