Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Michael Megaly, Marwan Saad, Peter Tajti, M. Nicholas Burke, Ivan Chavez, Mario Gössl, Daniel Lips, Michael Mooney, Anil Poulose, Paul Sorajja, Jay Traverse, Yale Wang, Louis P. Kohl, Steven M. Bradley, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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 4mL, (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 (-2.3mL, 95%CI -5.7 to 1.2mL, 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.

Original languageEnglish (US)
JournalJournal of Interventional Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Percutaneous Coronary Intervention
Left Ventricular Function
Stroke Volume
Meta-Analysis
Ventricular Remodeling
Observational Studies

Keywords

  • Chronic total occlusion
  • Ejection fraction
  • Left ventricular function
  • Left ventricular reverse remodeling

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling. / Megaly, Michael; Saad, Marwan; Tajti, Peter; Burke, M. Nicholas; Chavez, Ivan; Gössl, Mario; Lips, Daniel; Mooney, Michael; Poulose, Anil; Sorajja, Paul; Traverse, Jay; Wang, Yale; Kohl, Louis P.; Bradley, Steven M.; Brilakis, Emmanouil S.

In: Journal of Interventional Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Megaly, Michael ; Saad, Marwan ; Tajti, Peter ; Burke, M. Nicholas ; Chavez, Ivan ; Gössl, Mario ; Lips, Daniel ; Mooney, Michael ; Poulose, Anil ; Sorajja, Paul ; Traverse, Jay ; Wang, Yale ; Kohl, Louis P. ; Bradley, Steven M. ; Brilakis, Emmanouil S. / Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling. In: Journal of Interventional Cardiology. 2018.
@article{f34ca6246df947c491c8d159be090ac3,
title = "Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling",
abstract = "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 4mL, (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 (-2.3mL, 95{\%}CI -5.7 to 1.2mL, 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.",
keywords = "Chronic total occlusion, Ejection fraction, Left ventricular function, Left ventricular reverse remodeling",
author = "Michael Megaly and Marwan Saad and Peter Tajti and Burke, {M. Nicholas} and Ivan Chavez and Mario G{\"o}ssl and Daniel Lips and Michael Mooney and Anil Poulose and Paul Sorajja and Jay Traverse and Yale Wang and Kohl, {Louis P.} and Bradley, {Steven M.} and Brilakis, {Emmanouil S.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/joic.12538",
language = "English (US)",
journal = "Journal of Interventional Cardiology",
issn = "0896-4327",
publisher = "Wiley-Blackwell",

}

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.

PY - 2018/1/1

Y1 - 2018/1/1

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 4mL, (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 (-2.3mL, 95%CI -5.7 to 1.2mL, 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 4mL, (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 (-2.3mL, 95%CI -5.7 to 1.2mL, 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

UR - http://www.scopus.com/inward/record.url?scp=85050943894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050943894&partnerID=8YFLogxK

U2 - 10.1111/joic.12538

DO - 10.1111/joic.12538

M3 - Article

C2 - 29974508

AN - SCOPUS:85050943894

JO - Journal of Interventional Cardiology

JF - Journal of Interventional Cardiology

SN - 0896-4327

ER -