Pre-procedural chronic total occlusion in patients undergoing TAVI was not associated with increased in-hospital (RR 1.13; 95% CI 0.82-1.55) or 1-year all-cause mortality (RR 1.58; 95% CI 0.71-3.50).
Meta-Analysis (n=15,162)
Does the pre-procedural presence of chronic total occlusion alter outcomes in patients undergoing transcatheter aortic valve implantation?
In patients undergoing TAVI, the presence of unrevascularized CTO does not significantly increase short- or mid-term mortality, though it is associated with a higher risk of myocardial infarction.
Effect estimate: RR 1.13 (95% CI 0.82-1.55)
AIM: The pre-procedural presence of chronic total occlusions (CTO) in patients undergoing transcatheter aortic valve implantation (TAVI) could be a significant predictor of outcomes. This meta-analysis aims to investigate whether CTO presence significantly alters outcomes in TAVI patients. METHODS: A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After study selection, a random effect meta-analysis was performed. RESULTS: Seven studies with a total of 15,162 patients undergoing TAVI were included. There was no significant difference regarding in-hospital Relative Risk (RR): 1.13; 95% Confidence Interval (95% CI): 0.82-1.55 and 1-year all-cause mortality (RR: 1.58; 95% CI: 0.71-3.50). Patients with CTO exhibited significantly increased rates of myocardial infarction (RR: 1.27, 95% CI: 1.07-1.51) and reduced rates of new pacemaker implantation (RR: 0.88, 95% CI: 0.79-0.98). No differences were found in cardiogenic shock (RR: 1.18, 95% CI: 0.97-1.44), acute kidney injury (RR: 1.06, 95% CI: 0.88-1.28), vascular complications (RR: 1.10, 95% CI: 0.91-1.33), or bleeding (RR: 1.01, 95% CI: 0.89-1.14). CONCLUSION: In TAVI patients, pre-procedural unrevascularized CTO presence is not related to short- or mid-term increased mortality. Further studies are needed to identify predictors of adverse events and phenotypes benefiting from revascularization.
Dimitriadis et al. (Sun,) conducted a meta-analysis in transcatheter aortic valve implantation (TAVI) (n=15,162). Pre-procedural chronic total occlusion (CTO) vs. Absence of CTO was evaluated on in-hospital all-cause mortality (RR 1.13, 95% CI 0.82-1.55). Pre-procedural chronic total occlusion in patients undergoing TAVI was not associated with increased in-hospital (RR 1.13; 95% CI 0.82-1.55) or 1-year all-cause mortality (RR 1.58; 95% CI 0.71-3.50).