Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and failed percutaneous intervention of coronary chronic total occlusions

A Meta-Analysis of Observational Studies

Muhammad F. Khan, Emmanouil S. Brilakis, Christopher S Wendel, Hoang Thai

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. Methods We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44% versus 0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI] (1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus 3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03] and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI (4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful PCI arm. Conclusions As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes.

Original languageEnglish (US)
Pages (from-to)781-794
Number of pages14
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number5
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Observational Studies
Meta-Analysis
Confidence Intervals
Coronary Artery Bypass
Myocardial Infarction
Cardiac Tamponade
Hospital Mortality
Survival
Wounds and Injuries

Keywords

  • chronic total occlusions
  • meta-analysis
  • percutaneous coronary intervention
  • peri-procedural complications
  • short-term outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{59d3914581c64964854fe618870d35f2,
title = "Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and failed percutaneous intervention of coronary chronic total occlusions: A Meta-Analysis of Observational Studies",
abstract = "Background Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. Methods We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44{\%} versus 0.5{\%}) [relative risk (RR) of 2.88, 95{\%} confidence interval [CI] (1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88{\%} versus 3.75{\%}) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of in-hospital MI (3.17{\%} versus 2.4{\%}) [RR of 1.35, CI (1.03-1.78), P = 0.03] and increased need for urgent CABG (4.0{\%} versus 0.5{\%}) [RR of 6.67, CI (4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful PCI arm. Conclusions As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes.",
keywords = "chronic total occlusions, meta-analysis, percutaneous coronary intervention, peri-procedural complications, short-term outcomes",
author = "Khan, {Muhammad F.} and Brilakis, {Emmanouil S.} and Wendel, {Christopher S} and Hoang Thai",
year = "2015",
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pages = "781--794",
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TY - JOUR

T1 - Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and failed percutaneous intervention of coronary chronic total occlusions

T2 - A Meta-Analysis of Observational Studies

AU - Khan, Muhammad F.

AU - Brilakis, Emmanouil S.

AU - Wendel, Christopher S

AU - Thai, Hoang

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. Methods We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44% versus 0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI] (1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus 3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03] and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI (4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful PCI arm. Conclusions As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes.

AB - Background Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. Methods We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44% versus 0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI] (1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus 3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03] and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI (4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful PCI arm. Conclusions As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes.

KW - chronic total occlusions

KW - meta-analysis

KW - percutaneous coronary intervention

KW - peri-procedural complications

KW - short-term outcomes

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U2 - 10.1002/ccd.25712

DO - 10.1002/ccd.25712

M3 - Article

VL - 85

SP - 781

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JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

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