Prognostic Benefit of the Target Vessel in Revascularization of Chronic Total Occluded Coronary Arteries: A Systematic Review and Meta‐Analysis

ABSTRACT Background Previous data have implied that percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is dependent on target vessel. This systematic review and meta‐analysis aimed to investigate if the benefit of CTO revascularization with PCI is dependent on the target vessel. Methods A comprehensive search of multiple databases was conducted to identify studies investigating CTO patients undergoing PCI in the left anterior descending artery (LAD), right coronary artery (RCA), or left circumflex artery (LCX). Outcomes for patients with successful CTO PCI were compared with those who did not undergo PCI stratified on target vessel. The primary outcome was all‐cause mortality, while secondary outcomes included major adverse cardiac events (MACE) and cardiac death (CD). Results Twenty observational studies were included after screening of 3053 studies. Successful CTO PCI was associated with a lower risk of all‐cause mortality for LAD (Hazard ratio HR: 0.51 0.42, 0.62, p < 0.05, I 2 = 0%) and LCX (HR: 0.63 0.41, 0.97, p < 0.05, I 2 = 40%) than no revascularization. The risk of MACE was only signficantly reduced after successful CTO PCI for LAD lesions (HR: 0.55 0.47, 0.64, p < 0.05, I ² = 0%), but not for LCX (HR: 0.52 0.10, 2.62, p = 0.43, I ² = 73%) or RCA (HR: 0.65 0.19, 2.28, p = 0.50, I ² = 83%). Conclusions Successful CTO PCI in the LAD was consistently associated with lower all‐cause mortality, MACE, and CD compared to non‐revascularization, while results were variable for RCA and LCX. These findings emphasize the need for further randomized trials to clarify prognostic differences based on the target vessel.