Impact of Successful Recanalization of Chronic Total Occlusions Using Coronary Stents on Long-Term Clinical Outcomes: A Meta-Analysis

Background and Objectives: Although coronary stent implantation dramatically reduced the occurrences of restenosis and the needs for repeat revascularization, there is still uncertainty as to the prognostic impact of successful recanalization of Chronic Total Occlusion (CTO) lesion. The objective of this study was to determine the impact of successful CTO recanalization using coronary stent deployment on clinical outcomes. Subjects and Methods: Databases were searched for clinical studies that compared outcomes after successful recanalization of CTO lesions using coronary stent deployment with those of unsuccessful recanalization from January 2003 to March 2016. The end points of this study were mortality; Myocardial Infarction (MI); Major Adverse Cardiac Events (MACE); the need for Coronary Artery Bypass Graft Surgery (CABG); and angina relief at the longest follow-up. Results: Nineteen studies encompassing 12,598 patients with a median follow-up period of 12-60 months after successful vs. unsuccessful CTO recanalization using coronary stent were identified. There were 455 (5.0%) deaths of 9,041 patients after successful recanalization compared to 339 (10.3%) among 3,280 patients after unsuccessful recanalization (odds ratio [OR] 0.48, 95% Confidence Interval [CI] 0.38 to 0.61). Successful CTO recanalization significantly reduced the incidence of MI (OR 0.67, 95% CI 0.46 to 0.97) and MACE (OR 0.55, 95% CI 0.42 to 0.73). Successful CTO recanalization was associated with a lower need for subsequent CABG and higher angina relief. Conclusion: Successful recanalization of CTO lesions using coronary stents deployment appears to be associated with improvement in mortality and reduced needs for CABG as compared with unsuccessful PCI.