Evidence map›Paper›PMID 41929393›Full record

ArticleEuropean heart journal open2026

Overall coronary disease burden modifies the prognostic benefit of CTO-PCI: a SYNTAX score-stratified meta-analysis.

Nino Cocco, Kambis Mashayekhi, Agostino Spanò, Michael Behnes, Pierfrancesco Agostoni, Daniel Weilenmann, Claudiu Ungureanu, Giuseppe Colletti, Maourane Boukhris, Giulio Cocco and 4 more

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In one paragraph

Article in European heart journal open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Nino CoccoDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, Rome 00128, Italy.ORCID https://orcid.org/0000-0003-4981-3777
Kambis MashayekhiHeart Center Lahr, Internal Medicine and Cardiology, Hohbergweg, Lahr 77933, Germany.ORCID https://orcid.org/0000-0001-8119-8941
Agostino SpanòDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, Rome 00128, Italy.
Michael BehnesFirst Department of Medicine, University Hospital Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany.ORCID https://orcid.org/0000-0001-5970-0093
Pierfrancesco AgostoniHartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Middelheim Lindendreef 1, Antwerp 2020, Belgium.
Daniel WeilenmannCardiology, Cantonal Hospital St Gallen, Rorschacher Strasse 95, St Gallen 9007, Switzerland.
Claudiu UngureanuDepartment of Cardiology, Hôpital de Jolimont, Rue Ferrer 159, La Louvrière 7100, Belgium.ORCID https://orcid.org/0000-0002-1583-5882
Giuseppe CollettiDepartment of Cardiology, Hôpital d'Arlon, Arlon, Rue des Déportés 137, Arlon 6700, Belgium.ORCID https://orcid.org/0000-0002-6147-0925
Maourane BoukhrisCardiology Department, CHU Saint-Etienne, Avenue Albert Raimond 42055, Saint Étienne 42270, France.
Giulio CoccoDepartment of Medicine and Aging Sciences, University of Chieti G D'Annunzio, Via Vestini 31, Chieti 66100, Italy.
Cammalleri ValeriaDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, Rome 00128, Italy.
Annunziata NuscaDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, Rome 00128, Italy.ORCID https://orcid.org/0000-0002-5616-3197
Gian Paolo UssiaDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, Rome 00128, Italy.
Gregor LeibundgutUniversity Heart Center, University Hospital Basel, Petersgraben 4, Basel 4053, Switzerland.ORCID https://orcid.org/0000-0002-0122-5397

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: Extensive coronary artery disease (CAD) coexisting with chronic total occlusion (CTO) is associated with adverse outcomes, yet patients with advanced CAD are often underrepresented in randomized trials, and the prognostic impact of CTO percutaneous coronary intervention (CTO-PCI) across different levels of anatomical complexity remains uncertain. We aimed to determine whether the overall CAD burden, quantified by the SYNTAX score (SS), influences the prognostic effect of CTO-PCI. Methods and results: A systematic search of PubMed, Embase, Google Scholar, and Cochrane databases was conducted. Eligible studies compared successful CTO-PCI vs. no CTO-PCI and reported the mean SYNTAX score of the cohort. Two reviewers independently extracted data. The primary endpoint was annualized cardiovascular (CV) mortality. Pooled hazard ratios (HRs) were calculated using fixed- or random-effects models with inverse-variance weighting. Meta-regression explored the relationship between SS and CV mortality, and subgroup analyses were performed according to predefined SS categories. Seventeen studies (3 randomized and 14 prospective observational; n = 11 001) were included. Successful CTO-PCI was associated with significantly lower CV mortality compared with non-revascularization (HR 0.54; 95% CI 0.46-0.64; Conclusion: The survival benefit of CTO-PCI appears to increase with the extent of overall coronary disease, suggesting that patients with higher anatomical burden may derive greater prognostic benefit from successful CTO revascularization.

Indexed as

Cardiac sudden deathChronic total occlusionGlobal atherosclerotic burdenPercutaneous coronary interventionRefractory cardiac arrest

Identifiers

PMID41929393
PMCPMC13042282

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.