Table 1.
Recent CTO PCI Studies
| Study or Author | Study Type | Comparators | Study Population | Outcome of Interest | Results |
|---|---|---|---|---|---|
| EXPLORE (n=304) 9 | RCT | CTO PCI vs no CTO PCI | Post‐PCI STEMI patients with concurrent CTO | 4 mo LVEF and LVEDV assessed on cMRI | No difference between groups |
| DECISION‐CTO (n=834) 5 | RCT | CTO PCI+OMT vs OMT alone | Stable angina, nonsymptomatic ischemia, or ACS with CTO | 3 y death, MI, stroke, or repeated revascularization | No difference between groups |
| EURO‐CTO (n=396) 8 | RCT | CTO PCI+OMT vs OMT alone | Stable angina or equivalent with CTO in viable territory |
QOL by SAQ score (primary) 1 y death or nonfatal MI (secondary) |
Improved QOL in CTO PCI arm (primary) No difference between groups (secondary) |
| Galassi et al 2017 (n=839) 4 | Observational | CTO PCI in patients with LVEF ≥50%, 35%–50%, and ≤35% | Symptomatic patients undergoing elective CTO PCI with inducible ischemia in CTO territory | 2 y cardiac death, MI, stroke, or revascularization‐free survival | No difference among groups; highest benefit in LVEF ≤35% group |
| Jang et al 2014 (n=738) 14 | Observational | CTO treated with OMT alone vs OMT+CABG or PCI | CTO on angiogram with Rentrop 3 collateral circulation | 42 mo cardiac death, MACE (cardiovascular death, MI, repeated revascularization) | Significant lower incidence of cardiac death and MACEs in revascularization compared with OMT group |
| George et al 2014 (n=13 443) 11 | Observational | Successful vs unsuccessful CTO PCI | At least 1 CTO intervention |
Procedural success (primary) 5 y mortality (secondary) |
Procedural success of 70.6%; decreased mortality in those with successful revascularization compared with failed revascularization |
| Yang et al 2016 (n=1547) 13 | Observational | CTO PCI vs OMT | Symptomatic angina or +functional ischemia study with CTO | Cardiac death at follow‐up (median follow‐up, 45.8 mo) | No difference in rate of cardiac death between OMT and PCI groups |
| Goel et al 2018 (n=632) 12 | Observational | CTO PCI success vs failure | Consecutive cases with at least 1 CTO | Survival free of all adverse outcomes (death, MI, repeated PCI or CABG, recurrent angina) (median follow‐up, 2.9 y) |
Significantly higher event‐free survival in successful vs unsuccessful CTO PCI No difference in death or MI individually (subgroup analysis) |
| Tomasello et al 2015 (n=1777) 15 | Observational | CTO PCI vs OMT or CABG | At least 1 CTO | 1 y MACE, cardiac death | Significant lower incidence of MACEs and cardiac death in PCI compared with OMT or CABG group |
ACS indicates acute coronary syndrome; CABG, coronary artery bypass grafting; cMRI, cardiac magnetic resonance imaging; CTO, chronic total occlusion; DECISION‐CTO, Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion trial; EURO‐CTO, A Randomized Multicentre Trial to Compare Revascularization with Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions trial; EXPLORE, Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI trial; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular event; MI, myocardial infarction; OMT, optimal medical therapy; PCI, percutaneous coronary intervention; QOL, quality of life; RCT, randomized controlled trial; SAQ, Seattle angina questionnaire; and STEMI, ST‐segment–elevation MI.