Outcomes of chronic total occlusions in coronary arteries according to three therapeutic strategies: a meta-analysis with 6985 patients from 8 published observational studies
Rev. bras. cir. cardiovasc
;
34(6): 645-652, Nov.-Dec. 2019. tab, graf
Artigo
em Inglês
| LILACS
| ID: biblio-1057499
ABSTRACT
Abstract Objective:
To perform a systematic review and meta-analysis of studies comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT) in patients with chronic total occlusions (CTOs).Methods:
We identified eligible observational studies published in the China National Knowledge Infrastructure database, PubMed, Excerpta Medica database, Google Scholar, Cochrane Library, Web of Science, and "Clinical trials" registration from 1999 to October 2018. Main outcome measures were all-cause mortality, cardiac death, major adverse cardiac events (MACEs), and myocardial infarction (MI).Results:
There were eight observational studies including 6985 patients. Patients' mean age was 64.4 years. Mean follow-up time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients) presented decreased all-cause mortality (odd ratio [OR] 0.46, 95% confidence interval [CI] 0.36-0.60; P<0.001), cardiac death (OR 0.40, 95% CI 0.31-0.52; P<0.001), MACE (OR 0.55, 95% CI 0.43-0.71; P<0.001), and MI (OR 0.40, 95% CI 0.26-0.62; P<0.001). Comparing with MT, CABG (613 patients) presented lower all-cause mortality (OR 0.50, 95% CI 0.36-0.69; P<0.001) and MACE (OR 0.50, 95% CI 0.26-0.96; P=0.04), but not lower MI (OR 0.23, 95% CI 0.03-1.54; P=0.13) and cardiac death (OR 0.83, 95% CI 0.51-1.35). Comparing with CABG, PCI did not present decreased risk for those outcomes.Conclusions:
PCI or CABG was associated with better clinical outcome in patients with CTO than MT. PCI is not better than CABG in decreasing mortality, MI, cardiac death, and MACE in coronary CTO patients.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Oclusão Coronária
Tipo de estudo:
Estudo de etiologia
/
Estudo observacional
/
Estudo prognóstico
/
Fatores de risco
/
Revisões Sistemáticas Avaliadas
Limite:
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Rev. bras. cir. cardiovasc
Assunto da revista:
Cardiologia
/
Cirurgia Geral
Ano de publicação:
2019
Tipo de documento:
Artigo
País de afiliação:
China
Instituição/País de afiliação:
Xinjiang Medical University/CN
/
Zhengzhou University/CN
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