Friday 1719 – brilakis meta-analyses of clinical outcomes of patients who underwent pci for cto
1. EuroCTO Club 2015
Friday, September 18, 2015
Meta-analyses of clinical outcomes
of patients who underwent PCI for
CTO (including complications,
antero / retrograde)
17.19-17.32
Emmanouil S. Brilakis, MD, PhD
Director, Cardiac Catheterization Laboratories
VA North Texas Health Care System
Professor of Medicine, University of Texas
Southwestern Medical School, Dallas, Texas
2. Speaker honoraria/consulting fees:
Abbott Vascular, Asahi, Boston
Scientific, Elsevier, Somahlution, St
Jude Medical, Terumo
Research funding: InfraRedx, Boston
Scientific
Employment (spouse): Medtronic
Grants: VA - CLIN-007-11F
VA CSP#571 – DIVA
Disclosures
14. El Sabbagh,.., Brilakis. Int J Cardiol 2014;174:243-8
Retrograde CTO PCI: success and
complications meta-analysis
2006 – 4/2013
26 studies - 3,482 pts
60
80
100
Overall success
Retrograde success
83,3
74,5
%
0,7 0,7
1,4
6,9
2 2
5,4
0,5
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
%
vs 0.2 vs 0.1
vs 0.3
vs <0.01
15. From: Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-
Term Outcomes From the Multicenter ERCTO Registry
J Am Coll Cardiol. 2015;65(22):2388-2400. doi:10.1016/j.jacc.2015.03.566
23. Forest plot for long-term all-cause mortality with successful vs.
failed CTO PCI.
Christakopoulos G, Christopoulos G, Carlino M, Jeroudi O, Roesle M, Rangan BV, Abdullah S, Grodin J, Kumbhani D, Vo M,
Luna M, Alaswad K, Karmpaliotis D, Rinfret S, Garcia S, Banerjee S, Brilakis ES. Am J Cardiol 2015
25 studies
25,486 pts
24. Odds Ratios of most commonly reported clinical outcomes
based on subgroup.
Outcome Stents
Non-
Stents
DES
Non-
DES
CTO
duration
≥ 3
months
n/N (%)
CTO
duration
≤ 3
months
n/N (%)
Studies
published
before
2008
Studies
published
after 2008
All-cause
Mortality
0.44* 0.50* 0.51* 0.52* 0.47* 0.60* 0.50* 0.54*
MACE 0.45* 0.60* 0.38* 0.60* 0.57* 0.49* 0.60* 0.42*
MI 0.35* 0.95 0.39* 0.94 0.52 0.92 0.89 0.58*
CABG 0.15* 0.23* 0.12* 0.18* 0.16* 0.20* 0.22* 0.14*
25 studies
25,486 pts
Christakopoulos G, Christopoulos G, Carlino M, Jeroudi O, Roesle M, Rangan BV, Abdullah S, Grodin J, Kumbhani D, Vo M,
Luna M, Alaswad K, Karmpaliotis D, Rinfret S, Garcia S, Banerjee S, Brilakis ES. Am J Cardiol 2015
27. Hoebers L, Claessen BE, Elias J, Dangas GD, Mehran R, Henriques JPS.
Int J Cardiol 2015;187:90-96
Ejection fraction improvement
LVEF increase: 4.44% (95% CI: 3.52–5.35, p < 0.01)
LVEDV decrease: 6.14 ml/m2 (95% CI: − 9.31 to − 2.97, p < 0.01)
28.
29. O’Connor SA, Garot P, Sanguineti F, Hoebers L, Unterseeh T, Banamer H, Chevalier B,
Hovasse T, Morice MC, Lefevre T, Louvard Y. Am J Cardiol 2015;116:8e14
30. Complete vs. incomplete revascularization
Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES.
J Am Coll Cardiol. 2013;62:1421-1431
89,883 Patients
RR = 0.71 [0.65-0.77], p<0.001 .
12,259 out of 89,883
(13%) died during follow
up.
Mortality benefit in
patients treated with
CABG (RR 0.70; 95%
CI:0.61-0.80, p<0.001)
and PCI (RR 0.72, 95%
CI:0.64-0.81, p<0.001.
Mortality benefit did not
vary with definition of
CR.
40. 1st vs 2nd generation DES
Lanka et al. J Invasive Cardiol 2014;26:304-10
Target Vessel Revascularization
Target Lesion Revascularization
41. 1. CTO success rates has been
increasing with low
complication rates
2. If you do PCI you’d better
succeed!
3. CTO PCI ↑ EF
4. CTO in non-culprit STEMI lesion
= bad
5. 2nd gen DES > 1st gen DES >
BMS > PTCA
Conclusions