Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis

Ahmed Abdelaziz; Abdelrahman Hafez; Karim Atta; Hanaa Elsayed; Ahmed Elaraby; Ahmed A Ibrahim; Ahmed Farid Gadelmawla; Ahmed Helmi; Basel Abdelazeem; Carl J Lavie; Jose Tafur-Soto

doi:10.1016/j.cpcardiol.2024.102832

Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis

Curr Probl Cardiol. 2024 Sep 17;49(12):102832. doi: 10.1016/j.cpcardiol.2024.102832. Online ahead of print.

Authors

Affiliations

¹ Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
² Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Institute of Medicine, National Research Mordovia State University, Saransk, Russia.
³ Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
⁴ Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University, Menoufia, Egypt.
⁵ Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Alexandria University, Alexandria, Egypt.
⁶ Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Department of Cardiology, West Virginia University, Morgantown, WV, USA.
⁷ John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
⁸ John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA. Electronic address: jtafursoto@ochsner.org.

PMID: 39293774
DOI: 10.1016/j.cpcardiol.2024.102832

Abstract

Background: Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.

Methods: We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).

Results: A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).

Conclusion: Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.

Keywords: Antegrade; CTO; PCI; Retrograde.

Publication types

Review