Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions

a weighted meta-analysis of 18,061 patients from 65 studies.

Vishal G. Patel, Kimberly M. Brayton, Aracely Tamayo, Owen Mogabgab, Tesfaldet T. Michael, Nathan Lo, Mohammed Alomar, Deborah Shorrock, Daisha Cipher, Shuaib Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The safety profile of CTO PCI has received limited study. 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. 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%). CTO PCI carries low risk for procedural complications despite high success rates.

Original languageEnglish (US)
Pages (from-to)128-136
Number of pages9
JournalJACC. Cardiovascular interventions
Volume6
Issue number2
StatePublished - Feb 2013

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Meta-Analysis
Confidence Intervals
Percutaneous Coronary Intervention
Coronary Artery Bypass
Myocardial Infarction
Transplants
Stroke
Radiation Injuries
Mortality
Stents
Blood Vessels
Thrombosis
Hemorrhage
Safety
Skin

ASJC Scopus subject areas

  • Medicine(all)

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Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions : a weighted meta-analysis of 18,061 patients from 65 studies. / Patel, Vishal G.; Brayton, Kimberly M.; Tamayo, Aracely; Mogabgab, Owen; Michael, Tesfaldet T.; Lo, Nathan; Alomar, Mohammed; Shorrock, Deborah; Cipher, Daisha; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S.

In: JACC. Cardiovascular interventions, Vol. 6, No. 2, 02.2013, p. 128-136.

Research output: Contribution to journalArticle

Patel, Vishal G. ; Brayton, Kimberly M. ; Tamayo, Aracely ; Mogabgab, Owen ; Michael, Tesfaldet T. ; Lo, Nathan ; Alomar, Mohammed ; Shorrock, Deborah ; Cipher, Daisha ; Abdullah, Shuaib ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions : a weighted meta-analysis of 18,061 patients from 65 studies. In: JACC. Cardiovascular interventions. 2013 ; Vol. 6, No. 2. pp. 128-136.
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abstract = "This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The safety profile of CTO PCI has received limited study. 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. 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{\%}). CTO PCI carries low risk for procedural complications despite high success rates.",
author = "Patel, {Vishal G.} and Brayton, {Kimberly M.} and Aracely Tamayo and Owen Mogabgab and Michael, {Tesfaldet T.} and Nathan Lo and Mohammed Alomar and Deborah Shorrock and Daisha Cipher and Shuaib Abdullah and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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AU - Patel, Vishal G.

AU - Brayton, Kimberly M.

AU - Tamayo, Aracely

AU - Mogabgab, Owen

AU - Michael, Tesfaldet T.

AU - Lo, Nathan

AU - Alomar, Mohammed

AU - Shorrock, Deborah

AU - Cipher, Daisha

AU - Abdullah, Shuaib

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

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N2 - This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The safety profile of CTO PCI has received limited study. 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. 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%). CTO PCI carries low risk for procedural complications despite high success rates.

AB - This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The safety profile of CTO PCI has received limited study. 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. 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%). CTO PCI carries low risk for procedural complications despite high success rates.

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