Author + information
- Received October 5, 2012
- Accepted October 11, 2012
- Published online February 1, 2013.
- Vishal G. Patel, MD⁎,
- Kimberly M. Brayton, MD, JD⁎,
- Aracely Tamayo, MSW, MPH†,
- Owen Mogabgab, MD⁎,
- Tesfaldet T. Michael, MD, MPH⁎,
- Nathan Lo, MD⁎,
- Mohammed Alomar, MD⁎,
- Deborah Shorrock⁎,
- Daisha Cipher, PhD⁎,
- Shuaib Abdullah, MD⁎,
- Subhash Banerjee, MD⁎ and
- Emmanouil S. Brilakis, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Emmanouil S. Brilakis, Dallas Veterans Administration Medical Center (111A), 4500 South Lancaster Road, Dallas, Texas 75216
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.
Dr. Michael is supported by the T32HL007360 Cardiovascular Training Grant from the National Institutes of Health. Dr. Banerjee has reported that he has received research grants from Gilead and the Medicines Company; has received consultant/speaker honoraria from Covidien and Medtronic; and has ownership in MDCARE Global (spouse) and intellectual property in HygeiaTel. Dr. Brilakis has reported that he has received speaker honoraria from St. Jude Medical, Terumo, and Bridgepoint Medical and a research grant from Guerbet; his spouse is an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 5, 2012.
- Accepted October 11, 2012.
- American College of Cardiology Foundation