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Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis.
Li, Ka Hou Christien; Wong, Ka Hei Gabriel; Gong, Mengqi; Liu, Tong; Li, Guangping; Xia, Yunlong; Ho, Jeffery; Nombela-Franco, Luis; Sawant, Abhishek C; Eccleshall, Simon; Tse, Gary; Vassiliou, Vassilios S.
Afiliación
  • Li KHC; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Wong KHG; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Gong M; Faculty of Medicine, Newcastle University, Newcastle, UK.
  • Liu T; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Li G; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Xia Y; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
  • Ho J; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
  • Nombela-Franco L; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
  • Sawant AC; Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
  • Eccleshall S; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Tse G; Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
  • Vassiliou VS; Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Curr Atheroscler Rep ; 21(10): 42, 2019 08 09.
Article en En | MEDLINE | ID: mdl-31399762
PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT FINDINGS: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle-Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Vasos Coronarios / Oclusión Coronaria / Fibrinolíticos / Intervención Coronaria Percutánea Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Curr Atheroscler Rep Asunto de la revista: ANGIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Vasos Coronarios / Oclusión Coronaria / Fibrinolíticos / Intervención Coronaria Percutánea Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Curr Atheroscler Rep Asunto de la revista: ANGIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos