Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-analysis

Abstract

Objectives: Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion (CTO) in the non-infarct-associated artery (non-IRA) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (p-PCI). Methods: Various electronic databases were searched for studies published from inception to June, 2021. The primary endpoint was all-cause death, and the secondary endpoint was a composite of major adverse cardiac events (MACEs). Odds ratios (ORs) were pooled with 95% confidence intervals (CIs) for dichotomous data. Results: Seven studies involving 1540 participants were included in the final analysis. Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group (OR, 0.46; 95% CI, 0.23–0.95), cardiac death (OR, 0.43; 95% CI, 0.20–0.91), MACEs (OR, 0.47; 95% CI, 0.32–0.69) and heart failure (OR, 0.57; 95% CI, 0.37–0.89) compared with the occluded CTO group. No significant differences were observed between groups regarding myocardial infarction and repeated revascularization. Conclusions: Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.