TY - JOUR
T1 - Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention
AU - Megaly, Michael
AU - Buda, Kevin
AU - Karacsonyi, Judit
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Basir, Mir B.
AU - Mashayekhi, Kambis
AU - Rinfret, Stephane
AU - McEntegart, Margaret
AU - Yamane, Masahisa
AU - Azzalini, Lorenzo
AU - Alaswad, Khaldoon
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2022/11/15
Y1 - 2022/11/15
N2 - Objective: To compare the clinical outcomes after extraplaque (EP) versus intraplaque (IP) tracking in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The impact of modern dissection and reentry (DR) techniques on the long-term outcomes of CTO PCI remains controversial. Methods: We performed a systematic review and meta-analysis of studies that compared EP versus IP tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) are calculated using the Der-Simonian and Laird random-effects method. Results: Our meta-analysis included seven observational studies with 2982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO score, longer lesion length, and more severe calcification and had significantly longer stented segments. During a median follow-up of 12 months (range 9–12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI (1.10–2.06), p = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI (1.15–2.48), p = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI (0.67–2.78), p = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI (0.82–2.69), p = 0.20), stent thrombosis (OR 2.09, 95% CI (0.69–6.33), p = 0.19), or cardiac death (OR 1.10, 95% CI (0.39–3.15), p = 0.85) between IP and EP tracking. Conclusion: EP tracking is utilized in more complex CTOs and requires more stents. EP tracking is associated with a higher risk of MACE, driven by a higher risk of TVR at 1 year, but without an increased risk of death or MI compared with IP tracking. EP tracking is critically important for contemporary CTO PCI.
AB - Objective: To compare the clinical outcomes after extraplaque (EP) versus intraplaque (IP) tracking in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The impact of modern dissection and reentry (DR) techniques on the long-term outcomes of CTO PCI remains controversial. Methods: We performed a systematic review and meta-analysis of studies that compared EP versus IP tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) are calculated using the Der-Simonian and Laird random-effects method. Results: Our meta-analysis included seven observational studies with 2982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO score, longer lesion length, and more severe calcification and had significantly longer stented segments. During a median follow-up of 12 months (range 9–12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI (1.10–2.06), p = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI (1.15–2.48), p = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI (0.67–2.78), p = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI (0.82–2.69), p = 0.20), stent thrombosis (OR 2.09, 95% CI (0.69–6.33), p = 0.19), or cardiac death (OR 1.10, 95% CI (0.39–3.15), p = 0.85) between IP and EP tracking. Conclusion: EP tracking is utilized in more complex CTOs and requires more stents. EP tracking is associated with a higher risk of MACE, driven by a higher risk of TVR at 1 year, but without an increased risk of death or MI compared with IP tracking. EP tracking is critically important for contemporary CTO PCI.
KW - RDR
KW - antegrade dissection and reentry (ADR)
KW - chronic total occlusion (CTO)
KW - extraplaque
KW - intraplaque
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.30403
DO - 10.1002/ccd.30403
M3 - Article
C2 - 36168859
AN - SCOPUS:85139050578
SN - 1522-1946
VL - 100
SP - 1021
EP - 1029
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -