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Research paper
Published online: 2020-02-25
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The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis

Yejing Zhao, Hongyu Peng, Xiaonan Li, Jinghua Liu
DOI: 10.5603/CJ.a2020.0026
·
Pubmed: 32104900

open access

Ahead of print
Original articles
Published online: 2020-02-25

Abstract

Background: The meta-analysis was performed to evaluate the effect of dissection and re-entry (DR) vs. wire escalation (WE) techniques on long-term clinical outcomes in patients with chronic total occlusion (CTO) lesions undergoing percutaneous coronary intervention (PCI).

Methods: Studies were searched in electronic databases from inception to September, 2019. Results were pooled using random effects model and fixed effects model and are presented as risk ratios (RR) with 95% confidence intervals (CI).

Results: Pooled analyses revealed that patients with DR techniques had overall higher complexity CTO lesions than patients with WE techniques and required a greater number of stents and a greater mean stent length. The “extensive” DR techniques may have a higher incidence of target vessel revascularization (TVR) (RR = 2.30, 95% CI: 1.77–2.98), in-stent restenosis (RR = 1.71, 95% CI: 1.30–2.23), in-stent reocclusion (RR = 1.86, 95% CI: 1.03–3.3) and death/MI/TVR (RR = 2.10, 95% CI: 1.71–2.58), when compared with WE techniques, during the long-term follow-up. However, “limited” DR techniques result in more promising outcomes, and are comparable to conventional WE techniques.

Conclusions: Dissection and re-entry techniques were associated with increased risk of long-term negative clinical events, especially “extensive” DR techniques. However, “limited” DR techniques resulted in good long-term outcomes, comparable to WE techniques.

Abstract

Background: The meta-analysis was performed to evaluate the effect of dissection and re-entry (DR) vs. wire escalation (WE) techniques on long-term clinical outcomes in patients with chronic total occlusion (CTO) lesions undergoing percutaneous coronary intervention (PCI).

Methods: Studies were searched in electronic databases from inception to September, 2019. Results were pooled using random effects model and fixed effects model and are presented as risk ratios (RR) with 95% confidence intervals (CI).

Results: Pooled analyses revealed that patients with DR techniques had overall higher complexity CTO lesions than patients with WE techniques and required a greater number of stents and a greater mean stent length. The “extensive” DR techniques may have a higher incidence of target vessel revascularization (TVR) (RR = 2.30, 95% CI: 1.77–2.98), in-stent restenosis (RR = 1.71, 95% CI: 1.30–2.23), in-stent reocclusion (RR = 1.86, 95% CI: 1.03–3.3) and death/MI/TVR (RR = 2.10, 95% CI: 1.71–2.58), when compared with WE techniques, during the long-term follow-up. However, “limited” DR techniques result in more promising outcomes, and are comparable to conventional WE techniques.

Conclusions: Dissection and re-entry techniques were associated with increased risk of long-term negative clinical events, especially “extensive” DR techniques. However, “limited” DR techniques resulted in good long-term outcomes, comparable to WE techniques.

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Keywords

chronic total occlusion, percutaneous coronary intervention, dissection and re-entry, wire escalation, meta-analysis

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About this article
Title

The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-02-25

DOI

10.5603/CJ.a2020.0026

Pubmed

32104900

Keywords

chronic total occlusion
percutaneous coronary intervention
dissection and re-entry
wire escalation
meta-analysis

Authors

Yejing Zhao
Hongyu Peng
Xiaonan Li
Jinghua Liu

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