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 - 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 -