A new meta-analysis shows that older adults may reap more quality of life (QoL) benefits when undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) instead of optimal medical therapy (OMT). Yasser Jamil, MD, from Inova Schar Heart and Vascular, Falls Church, Virginia, and colleagues, reported these results in a manuscript published online in JACC: Advances. CTO is difficult to treat in older adults, and data on best management strategies is lacking. The investigators in this study compared the use of CTO-PCI with OMT in this patient population from studies across 6 databases. All-cause death, QoL and cardiovascular outcomes were compared between the groups. A total of 19,282 patients (weighted mean age of overall population=67.0 years, 76% male) across 29 studies were included, and 28 of these studies were observational. CTO-PCI was compared with OMT in 18 studies, while successful CTO-PCI and failed CTO-PCI were compared in 11 studies. Patients who received attempted CTO-PCI had significantly lower rates of cardiac death (risk ratio [RR]=0.55; 95% confidence interval [CI]=0.40-0.76), all-cause death (RR=0.61; 95% CI-0.50-0.75), and major adverse cardiovascular events (RR=0.68; 95% CI=0.60-0.78). Both groups had similar rates of myocardial infarction and revascularization. When investigators compared successful versus failed CTO-PCI, only cardiac death and all-cause death were reduced. QoL outcomes were only measured in 4 of the 29 studies, but in these 4 studies patients who had successful CTO-PCI had better improvements compared with the OMT group and patients who had failed CTO-PCI. Due to most of the studies in these analyses being observational, the authors of this manuscript suggest these results be hypothesis-generating rather than implemented into clinical practice. Prospective, randomized clinical trials are needed to further these results. Overall, observational trials show successful CTO-PCI improves QoL and clinical outcomes compared with OMT. Source: Jamil Y, Dermksian M, Ghazawi AE, et al. Percutaneous coronary intervention or medical therapy for chronic total occlusion in older adults. JACC Advances. 2025 November (Article in press). Image Credit: Rasi – stock.adobe.com