Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling
Michael Megaly MD, MS
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
Search for more papers by this authorMarwan Saad MD, PhD
Department of Cardiovascular Medicine, University of Arkansas, Little Rock, Arkansas
Search for more papers by this authorPeter Tajti MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorM. Nicholas Burke MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorIvan Chavez MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorMario Gössl MD, PhD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorDaniel Lips MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorMichael Mooney MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorAnil Poulose MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorPaul Sorajja MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorJay Traverse MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorYale Wang MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorLouis P. Kohl MD
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
Search for more papers by this authorSteven M. Bradley MD, MPH
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorCorresponding Author
Emmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Correspondence
Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN 55407.
Email: [email protected]
Search for more papers by this authorMichael Megaly MD, MS
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
Search for more papers by this authorMarwan Saad MD, PhD
Department of Cardiovascular Medicine, University of Arkansas, Little Rock, Arkansas
Search for more papers by this authorPeter Tajti MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorM. Nicholas Burke MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorIvan Chavez MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorMario Gössl MD, PhD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorDaniel Lips MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorMichael Mooney MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorAnil Poulose MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorPaul Sorajja MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorJay Traverse MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorYale Wang MD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorLouis P. Kohl MD
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
Search for more papers by this authorSteven M. Bradley MD, MPH
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Search for more papers by this authorCorresponding Author
Emmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
Correspondence
Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN 55407.
Email: [email protected]
Search for more papers by this authorAbstract
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.
Supporting Information
Additional supporting information may be found online in the Supporting Information section at the end of the article.
| Filename | Description |
|---|---|
| joic12538-sup-0001-SuppFig-S1.jpg16.7 KB |
Figure S1. Funnel plot studies evaluating the impact of successful CTO PCI on left ventricular ejection fraction. |
| joic12538-sup-0002-SuppFig-S2.jpg24.3 KB |
Figure S2. Funnel plot studies evaluating the impact of successful CTO PCI on left ventricular end-systolic volume. |
| joic12538-sup-0003-SuppFig-S3.jpg24.3 KB |
Figure S3. Funnel plot studies evaluating the impact of successful CTO PCI on left ventricular end-diastolic volume. |
| joic12538-sup-0004-SuppFig-S4.png5.3 KB |
Figure S4. Funnel plot studies evaluating the impact of failed CTO PCI on left ventricular ejection fraction. |
| joic12538-sup-0005-SuppTab-S1.docx26.3 KB |
Table S1. Baseline characteristics of the patients that were included in the meta-analysis studies. |
| joic12538-sup-0006-SuppTab-S2.docx15 KB |
Table S2. Demographics of the patients in the included studies. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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