TY - JOUR
T1 - Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling
AU - Megaly, Michael
AU - Saad, Marwan
AU - Tajti, Peter
AU - Burke, M. Nicholas
AU - Chavez, Ivan
AU - Gössl, Mario
AU - Lips, Daniel
AU - Mooney, Michael
AU - Poulose, Anil
AU - Sorajja, Paul
AU - Traverse, Jay
AU - Wang, Yale
AU - Kohl, Louis P.
AU - Bradley, Steven M.
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Michael Megaly, Marwan Saad, Peter Tajti, MD, M. Nicholas Burke, MD, Ivan Chavez, MD, Mario Gössl, MD, PhD, Daniel Lips, MD, Michael Mooney, MD, Anil Poulose, MD, Jay Traverse, MD, Yale Wang, MD, Louis P. Kohl, MD, and Steven M. Bradley, MD, MPH, have nothing to disclose. Paul Sorajja, MD, consulting, speaking for Abbott, Edwards, Medtronic, and BSCI. Emmanouil Brilakis: consulting/speaker honoraria from Abbott Vascular, ACIST, American Heart Association (associate editor Circulation), Amgen, Asahi, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, and Medtronic; research support from Boston Scientific and Osprey. Shareholder: MHI Ventures. Board of Trustees: Society of Cardiovascular Angiography and Interventions
Funding Information:
Michael Megaly, Marwan Saad, Peter Tajti, MD, M. Nicholas Burke, MD, Ivan Chavez, MD, Mario Gössl, MD, PhD, Daniel Lips, MD, Michael Mooney, MD, Anil Poulose, MD, Jay Traverse, MD, Yale Wang, MD, Louis P. Kohl, MD, and Steven M. Bradley, MD, MPH, have nothing to disclose. Paul Sorajja, MD, consulting, speaking for Abbott, Edwards, Medtronic, and BSCI. Emmanouil Brilakis: consulting/speaker honoraria from Abbott Vascular, ACIST, American Heart Association (associate editor Circulation), Amgen, Asahi, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, and Medtronic; research support from Boston Scientific and Osprey. Shareholder: MHI Ventures. Board of Trustees: Society of Cardiovascular Angiography and Interventions.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/10
Y1 - 2018/10
N2 - Background: We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function. Methods: We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function. Results: A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7.9 months, successful CTO PCI was associated with an increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001, I2 = 45%). In secondary analysis of 15 studies (1248 patients) that defined CTOs as occlusions of at least 3-month duration and reported follow-up of at least 3-months after the procedure, successful CTO PCI was associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV end-systolic volume, successful CTO PCI was associated with a decrease in LV end-systolic volume by 4 mL, (95%CI −6.0 to −2.1, P < 0.0001, I2 = 0%). LV end-diastolic volume was reported in 9 studies with 403 patients and did not significantly change after successful CTO PCI (−2.3 mL, 95%CI −5.7 to 1.2 mL, P = 0.19, I2 = 0%). Conclusions: Successful CTO PCI is associated with a statistically significant improvement in LV ejection fraction and decrease in LV end-systolic volume, that may reflect a beneficial effect of CTO recanalization on LV remodeling. The clinical implications of these findings warrant further investigation.
AB - Background: We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function. Methods: We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function. Results: A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7.9 months, successful CTO PCI was associated with an increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001, I2 = 45%). In secondary analysis of 15 studies (1248 patients) that defined CTOs as occlusions of at least 3-month duration and reported follow-up of at least 3-months after the procedure, successful CTO PCI was associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV end-systolic volume, successful CTO PCI was associated with a decrease in LV end-systolic volume by 4 mL, (95%CI −6.0 to −2.1, P < 0.0001, I2 = 0%). LV end-diastolic volume was reported in 9 studies with 403 patients and did not significantly change after successful CTO PCI (−2.3 mL, 95%CI −5.7 to 1.2 mL, P = 0.19, I2 = 0%). Conclusions: Successful CTO PCI is associated with a statistically significant improvement in LV ejection fraction and decrease in LV end-systolic volume, that may reflect a beneficial effect of CTO recanalization on LV remodeling. The clinical implications of these findings warrant further investigation.
KW - chronic total occlusion
KW - ejection fraction
KW - left ventricular function
KW - left ventricular reverse remodeling
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U2 - 10.1111/joic.12538
DO - 10.1111/joic.12538
M3 - Article
C2 - 29974508
AN - SCOPUS:85050943894
SN - 0896-4327
VL - 31
SP - 562
EP - 571
JO - Journal of Interventional Cardiology
JF - Journal of Interventional Cardiology
IS - 5
ER -