Compared with optimal medical therapy, attempted CTO-PCI in older adults was significantly associated with reductions in cardiac death (RR 0.55; 95% CI 0.40-0.76) and all-cause mortality.
Meta-Analysis (n=19,282)
Does attempted or successful CTO-PCI reduce mortality and cardiovascular events or improve quality of life compared to optimal medical therapy in older adults with chronic total occlusion?
In older adults with chronic total occlusion, attempted or successful PCI may be associated with reduced mortality and improved quality of life compared to medical therapy, though evidence is primarily observational.
Effect estimate: RR 0.55 (95% CI 0.40-0.76)
BACKGROUND: Managing coronary chronic total occlusion (CTO) in older adults remains challenging due to a scarcity of evidence. OBJECTIVES: We aimed to assess the association of attempted/successful CTO percutaneous coronary intervention (CTO-PCI) with quality of life (QoL) measures, all-cause mortality, and cardiovascular outcomes in studies that adequately represented older adults. METHODS: A systematic search of 6 databases was performed to identify randomized trials and observational studies comparing CTO-PCI with optimal medical therapy (OMT) in adults, with particular inclusion of studies adequately representing older individuals. Meta-regression analyses were conducted to estimate relative risks (RRs) for key outcomes. RESULTS: A total 29 studies encompassing 19,282 patients were included, of which 28 were observational. Compared with OMT, attempted CTO-PCI was significantly associated with reductions in cardiac death (RR: 0.55; 95% CI: 0.40-0.76), all-cause mortality (RR: 0.61; 95% CI: 0.50-0.75), and major adverse cardiovascular events (RR: 0.68; 95% CI: 0.60-0.78). Rates of myocardial infarction and revascularization were similar between groups. In analyses comparing successful vs failed CTO-PCI, only cardiac death and all-cause mortality were reduced. In addition, among the 4 studies that evaluated QoL, attempted/successful CTO-PCI yielded greater improvements than OMT/failed PCI. Evidence for the above results were derived from observational studies and remained less certain. CONCLUSIONS: In older adults, attempted or successful CTO-PCI may be associated with improved QoL and favorable cardiovascular outcomes compared with OMT; however, as these findings are largely derived from observational studies, they should be viewed as hypothesis-generating. Randomized trials in representative older populations are needed to confirm these associations.
Jamil et al. (Wed,) conducted a meta-analysis in coronary chronic total occlusion (CTO) (n=19,282). attempted CTO-PCI vs. optimal medical therapy (OMT) was evaluated on cardiac death (RR 0.55, 95% CI 0.40-0.76). Compared with optimal medical therapy, attempted CTO-PCI in older adults was significantly associated with reductions in cardiac death (RR 0.55; 95% CI 0.40-0.76) and all-cause mortality.