Efficacy of previous failure on subsequent procedural outcomes of chronic total occlusion percutaneous coronary intervention: A systematic review and meta-analysis

Abstract

Objective: The current study aimed to review evidence on the effects of prior failed percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on subsequent reattempted procedures.

Methodology: Studies published on the databases of PubMed, Embase, Scopus, and Web of Science comparing outcomes of prior failed CTO-PCI with first-attempt CTO-PCI were included. Random-effects meta-analysis was conducted for baseline characteristics, success rates, and complications.

Results: Six studies were included with 15,803 patients of which 3248 (20.6%) had prior failed PCI for CTO. Patients with prior failed CTO-PCI had significantly lower age, higher Japanese-CTO scores, higher incidence of tortuous vessels, increased contrast volume, and higher fluoroscopy time. The retrograde approach was more frequently used in prior failed cases. Meta-analysis showed that procedural (OR: 0.50 95% CI: 0.32, 0.77 I2=89%) and technical success (OR: 0.69 95% CI: 0.53, 0.88 I2=68%) was significantly lower in cases with prior failed CTO-PCI as compared to those undergoing first attempt CTO-PCI. There was no difference in the risk of major adverse cardiac events (OR: 1.14 95% CI: 0.62, 2.09 I2=47%) and individual complications between the two groups.

Conclusions: Evidence suggest that cases with prior failed CTO-PCI may have significantly lower procedural and technical success rates as compared to those undergoing first-attempt CTO-PCI. There may be no difference in the risk of complications between the two groups. High heterogeneity precludes strong conclusions. Further studies are needed to improve the quality of evidence.