Long‐Term Survival and Angina After Chronic Total Occlusion Percutaneous Coronary Intervention Compared With Medical Therapy: A Meta‐Analysis
Bibliographic record
Abstract
hether percutaneous coronary intervention (PCI) is the optimal treatment for patients with chronic total coronary occlusion (CTO) remains controversial.Although technical improvements have yielded higher success rates of CTO-PCI, a beneficial effect on mortality or myocardial infarction has not yet been proven by previous randomized studies.However, some of these studies suggest a favorable impact on quality of life and angina symptoms after CTO-PCI.Therefore, American and European guidelines support PCI in patients with CTO with refractory angina despite medical therapy, while acknowledging the uncertainty regarding angina symptom reduction.There are 6 randomized controlled trials (RCTs) involving patients with CTO that investigated outcomes after CTO-PCI versus medical therapy.Most of these RCTs were underpowered to adequately evaluate mortality and clinical symptoms.In addition, 2 trials were discontinued prematurely.1,2 Previous meta-analyses showed no effect of CTO-PCI on clinical outcomes at short-term follow-up and lower angina rates at 1 year of follow-up.However, long-term data are missing.Therefore, we pooled the data of 5 RCTs, excluding 1 based on the fact that only CTOs in the right coronary artery were included and no data on clinical symptoms were reported, to investigate the short-(6-12 months), mid-(3-5 years), and long-term (10 years) risk of allcause mortality and presence of angina between CTO-PCI and medical therapy.[1][2][3][4][5] This was a study-level meta-analysis with data provided by researchers of 3 of the 5 included trials 3-5 or retrieved from the original publication for the other 2 trials, 1,2 including their figures using Digitize It software.Presence of angina was assessed using the Seattle Angina Questionnaire or the Canadian Cardiovascular Society (CCS) Angina Grade.The data that support the findings of this meta-analysis are available upon reasonable request.Because this is a meta-analysis of RCTs, no institutional review board approval was required, but informed consent was obtained for all included RCTs in accordance with their respective study protocols.All 5 RCTs investigated CTO-PCI compared with medical therapy.We created funnel plots for all-cause death and angina to test for asymmetry of the data by
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.014 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.049 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".