Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis

Introduction: Chronic total occlusion (CTO) of coronary arteries has traditionally been managed with medical therapy and coronary artery bypass grafting (CABG). With advances in interventional technology, percutaneous coronary intervention (PCI) success rates have improved, prompting reassessment of PCI as a treatment for CTO. Objective: To compare clinical outcomes of PCI versus CABG in patients with CTO. Methods: Systematic searches of PubMed, Embase, and Web of Science (2000–March 2023) identified studies comparing PCI and CABG in CTO. Primary endpoints were major adverse cardiac events (MACE) and all-cause mortality; secondary endpoints were myocardial infarction (MI), cardiac death, and repeat revascularization. Nine studies (n=8,674) with a mean follow-up of 4.3 years were included. Results: Compared with CABG, PCI was associated with lower all-cause mortality and cardiac death, but higher repeat revascularization; no significant difference was observed in MACE. Conclusions: In CTO, PCI may reduce all-cause mortality and cardiac death relative to CABG but is associated with more repeat revascularization; MACE rates were similar. Further research is needed to guide optimal revascularization strategy.

Chenyang Wang, Sheng Liu, Raimov Kamronbek, Siyao Ni, Yunjiu Cheng, Huiyuan Yan, Ming Zhang