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Bridging the Gap: A Comprehensive Meta-Analysis on Surgical Revascularization for Chronic Coronary Total Occlusions
Session:
Sessão de Posters 25 - Cirurgia cardíaca
Speaker:
Ana L. Silva
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Ana L. Silva; Gonçalo Ferraz Costa; Gonçalo Terleira Batista; Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Joana Guimarães; Diogo de Almeida Fernandes; Eric Monteiro; Luís Leite; José Luís Martins; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Chronic coronary total occlusions (CTOs) optimal therapeutic management remains a topic of debate despite its association with adverse clinical outcomes<strong>.</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To compare the clinical outcomes of patients with CTO treated with surgical revascularization versus medical therapy (MT), assessing the effect of CTO revascularization in patients with multivessel disease undergoing coronary artery bypass graft (CABG).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: In July 2023, PubMed, Embase, Cochrane, and Web of Science databases were systematically searched for observational and interventional studies comparing CTOs treated with CABG versus MT. We then performed a sub-analysis of studies with patients submitted to CABG comparing complete surgical revascularization, including CTO bypass, versus revascularization without CTO bypass. A pooled odds ratio meta-analysis was conducted for four main outcomes: mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Random-effects meta-analysis was performed with Review Manager 5.4.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Ten observational studies, including 6,458 patients, compared CABG-CTO with MT-CTO (65.9% MT; 34.1% CABG). Meta-analysis indicated significantly lower all-cause mortality in the CABG group (OR 0.31, 95% CI 0.24-0.40, p<0.001, I<sup>2</sup>=36%). Despite high heterogeneity, CABG exhibited reduced CV mortality and MACE (OR 0.37, 95% CI 0.24-0.57, p<0.001, I<sup>2</sup>=59%; OR 0.37, 95% CI 0.15-0.92, p=0.03, I<sup>2</sup>=80%, respectively). Additionally, the MI rate was lower in the CABG group (OR 0.41, 0.30-0.56, p<0.001, I<sup>2</sup>=0%). The stroke rate did not differ significantly between the two treatment groups (OR 3.54, 95% CI 0.73-17.17, p=0.12, I<sup>2</sup>=71%). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In the comparative analysis between the bypassed and non-bypassed CTO groups involving five studies (1,949 patients, 73.7% vs 26.3%, respectively), the bypassed-CTO group exhibited a statistically significant lower MACE (OR 0.49, 95% CI 0.30-0.81, p=0.005, I<sup>2</sup>=44%). All-cause mortality nearly reached statistical significance (OR 0.64, 95% CI 0.40-1.02, p=0.06, I<sup>2</sup>=57%). No differences were found in MI (OR 0.86, 95% CI 0.39-1.86, p=0.70, I<sup>2</sup>=47%) and stroke (OR 0.95, 95% CI 0.53-1.68, p=0.85, I<sup>2</sup>=0%) between the abovementioned groups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Our study suggests a clinical benefit of bypassing a CTO lesion in patients with multivessel disease undergoing CABG, with a significantly lower MACE and a marginally close value observed for all-cause mortality. The improved clinical outcomes of CABG over MT of CTO lesions further underscore the potential advantages of revascularizing a CTO during CABG rather than leaving it untreated, warranting careful consideration by the Heart Team during their decision-making.</span></span></p>
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