{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:17:56Z","timestamp":1787771876003,"version":"build-2784847793"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"\n \n Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has substantially improved due to increasing operator experience and advancements in equipment, techniques, and management algorithms. However, the overall benefit of CTO PCI remains controversial, particularly since only a few randomized trials have been reported to date.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We performed a meta-analysis to evaluate the efficacy of CTO PCI. The study outcomes were the occurrence of all-cause mortality, myocardial infarction, repeat revascularization, stroke, or freedom from angina at the longest documented follow-up period.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In five trials including 1790 patients, the mean age was 63 \u00b1 10 years, 17% were female, with a median follow-up of 2.9 years. The procedural success rate ranged from 73% to 97% and the right coronary artery was the most involved artery (52%). There was no significant difference between CTO PCI and no intervention regarding all-cause mortality (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.49\u20132.47,\n P<\/jats:italic>\n = 0.82), myocardial infarction (OR: 1.20, 95% CI: 0.81\u20131.77,\n P<\/jats:italic>\n = 0.36), repeat revascularization (OR: 0.67, 95% CI: 0.40\u20131.14,\n P<\/jats:italic>\n = 0.14), or stroke (OR: 0.60, 95% CI: 0.26\u20131.36,\n P<\/jats:italic>\n = 0.22). In two trials including 686 patients, significantly more patients were free of angina at 1 year, defined as the Canadian Cardiovascular Society grading of angina pectoris Grade 0, in the CTO PCI group compared to the no intervention group (OR: 0.52, 95% CI: 0.35\u20130.76,\n P<\/jats:italic>\n < 0.001). Meta-regression analyses based on various trial-level covariates (gender, diabetes, previous myocardial infarction, PCI or coronary artery bypass graft, SYNTAX or J-CTO scores, and CTO-related artery percentages) did not suggest any statistically significant relationships.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n CTO PCI appears to have a similar efficacy profile compared to no intervention at long-term follow-up, but with a significant improvement of angina favoring PCI-treated patients. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/heartviews.heartviews_82_22","type":"journal-article","created":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T07:35:14Z","timestamp":1707550514000},"page":"104-108","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Meta-analysis Comparing Long-Term Clinical Outcomes of Percutaneous Coronary Intervention versus no Intervention in Patients with Chronic Total Occlusion"],"prefix":"10.4103","volume":"24","author":[{"given":"Abdalazeem","family":"Ibrahem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Farag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying X.","family":"Gue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Spinthakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Al-Atta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohaned","family":"Egred","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-4-20240902","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1161\/CIRCULATIONAHA.120.046754","article-title":"Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations","volume":"143","author":"Ybarra","year":"2021","journal-title":"Circulation"},{"key":"R2-4-20240902","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1093\/eurheartj\/ehl270","article-title":"The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction","volume":"27","author":"Werner","year":"2006","journal-title":"Eur Heart J"},{"key":"R3-4-20240902","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/ccd.25001","article-title":"The myocardium supplied by a chronic total occlusion is a persistently ischemic zone","volume":"83","author":"Sachdeva","year":"2014","journal-title":"Catheter Cardiovasc Interv"},{"key":"R4-4-20240902","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.1093\/eurheartj\/ehv450","article-title":"Management strategies in patients affected by chronic total occlusions: Results from the Italian registry of chronic total occlusions","volume":"36","author":"Tomasello","year":"2015","journal-title":"Eur Heart J"},{"key":"R5-4-20240902","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jcin.2014.10.010","article-title":"Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation","volume":"8","author":"Jang","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"R6-4-20240902","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1161\/CIRCULATIONAHA.119.039797","article-title":"Guiding principles for chronic total occlusion percutaneous coronary intervention","volume":"140","author":"Brilakis","year":"2019","journal-title":"Circulation"},{"key":"R7-4-20240902","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.jelectrocard.2018.07.012","article-title":"The effect of revascularization of a chronic total coronary occlusion on electrocardiographic variables. A sub-study of the EXPLORE trial","volume":"51","author":"van Dongen","year":"2018","journal-title":"J Electrocardiol"},{"key":"R8-4-20240902","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jcmg.2020.10.012","article-title":"Impact of chronic total occlusion revascularization on left ventricular function assessed by cardiac magnetic resonance","volume":"14","author":"Megaly","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"R9-4-20240902","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1161\/CIRCOUTCOMES.108.825760","article-title":"Quantifying the early health status benefits of successful chronic total occlusion recanalization: Results from the FlowCardia\u2019s approach to chronic total occlusion recanalization (FACTOR) trial","volume":"3","author":"Grantham","year":"2010","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"R10-4-20240902","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1093\/eurheartj\/ehy220","article-title":"A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions","volume":"39","author":"Werner","year":"2018","journal-title":"Eur Heart J"},{"key":"R11-4-20240902","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2016.07.744","article-title":"Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: The EXPLORE trial","volume":"68","author":"Henriques","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"R12-4-20240902","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.jcin.2018.04.017","article-title":"The IMPACTOR-CTO trial","volume":"11","author":"Obedinskiy","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"R13-4-20240902","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1016\/j.jcin.2018.05.041","article-title":"A Randomized trial to assess regional left ventricular function after stent implantation in chronic total occlusion: The REVASC trial","volume":"11","author":"Mashayekhi","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"R14-4-20240902","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1161\/CIRCULATIONAHA.118.031313","article-title":"Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion","volume":"139","author":"Lee","year":"2019","journal-title":"Circulation"},{"key":"R15-4-20240902","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jcin.2020.10.003","article-title":"Association of Acute Procedural Results With Long-Term Outcomes After CTO PCI","volume":"14","author":"Guan","year":"2021","journal-title":"JACC Cardiovasc Interv"}],"container-title":["Heart Views"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_82_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:19:05Z","timestamp":1787768345000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_82_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/heartviews.heartviews_82_22","relation":{},"ISSN":["1995-705X"],"issn-type":[{"value":"1995-705X","type":"print"}],"subject":[],"published":{"date-parts":[[2023,4]]}}}