Comparison Of The Prognosis Of Percutaneous Coronary Intervention And Optimal Medical Therapy For Patients With Chronic Total Occlusions In Different Target Vessels-A Meta Analysis

Background:In recent years,along with the improvement of the percutaneous coronary intervention(PCI)for chronic total occlusion(CTO),more and more procedures were successful.Now the cardiac physicians don’t doubt that PCI can relieve patients’symptoms,however,they are arguing on that PCI could decrease mortality risk or not.Since Safley et al raised that PCI could reduce mortality only when the CTOs were in left anterior descending artery(LAD)in 2008,PCI operators prefer to recanalize the CTO in LAD.Nevertheless,more and more related literatures with different outcomes were published.Methods:Literatures that compared PCI and optimal medical therapy(OMT)for CTO in different target vessels and analyzed the risk of all-cause mortality,cardiac death,or MACE were searched in great databases such as Pubmed,Web of Science,Scopus,Sciencedirect,Embase,Ovid MEDLINE,and Cochrane.STATA was used to operate a Meta-analysis,in order to study if PCI could reduce the above-mentioned risk or not.Results:In the end,22 literatures were included in the study.The outcomes suggest that:compared with OMT,for patients with a CTO in LAD,PCI can decrease the risk of all-cause mortality(HR=0.62,95%CI;0.49-0.78,I~2=0.0%),and the risk of cardiac death(HR=0.29,95%CI:0.19-0.46,I~2=0.0%),but can’t decrease the risk of major adverse cardiovascular events(MACE)(HR=0.64,95%CI:0.32-1.27,I~2=77.7%);for patients with a CTO in left circumflex artery(LCX),PCI can reduce the risk of all-cause mortality(HR=0.60,95%CI:0.45-0.79,I~2=49.3%),and the risk of cardiac death(HR=0.37,95%CI:0.24-0.58,I~2=0.0%),but can’t reduce the risk of MACE(HR=0.97,95%CI:0.41-2.31,I~2=58.0%);for patients with a CTO in right coronary artery(RCA),PCI can decrease the risk of all-cause mortality(HR=0.74,95%CI:0.60-0.90,I~2=15.9%),the risk of cardiac death(HR=0.37,95%CI:0.24-0.58,I~2=0.0%),and the risk of MACE(HR=0.65,95%CI:0.44-0.94,I~2=0.0%).Conclusions:Compared with OMT,for patients with a CTO in LAD,LCX or RCA,PCI can reduce the risk of all-cause mortality,cardiac death;for patients with a CTO in RCA,PCI can also reduce the risk of MACE,however,for patients with a CTO in LAD or LCX,there isn’t significant difference in the risk of MACE.