Suero J A, Marso S P, Jones P G, Laster S B, Huber K C, Giorgi L V, Johnson W L, Rutherford B D
Mid-America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA.
J Am Coll Cardiol. 2001 Aug;38(2):409-14. doi: 10.1016/s0735-1097(01)01349-3.
The study compared procedural outcomes and long-term survival for patients undergoing percutaneous coronary intervention (PCI) of a chronic total coronary artery occlusion (CTO) with a matched non-CTO cohort to determine whether successful PCI of a CTO is associated with improved survival.
Percutaneous coronary intervention of a CTO is a common occurrence, and the long-term survival for patients with successful PCI of a CTO has not been clearly defined.
Between June 1980 and December 1999, a total of 2,007 consecutive patients underwent PCI for a CTO. Utilizing propensity scoring methods, a matched non-CTO cohort of 2,007 patients was identified and compared to the CTO group. The cohorts were stratified into successful and failed procedures.
The in-hospital major adverse cardiac event (MACE) rate was 3.8% in the CTO cohort. Technical success has improved over the last 10 years (overall 74.4%, slope 1.0%/yr, p = 0.02, R2 = 49.9%) as did procedural success (overall 69.9%, slope 1.2%/yr, p = 0.02, R2 = 51.5%) without a concomitant increase in in-hospital MACE rates (slope 0.1%/yr, p = 0.7). There was a distinct 10-year survival advantage for successful CTO treatment compared with failed CTO treatment (73.5% vs. 65.1%, p = 0.001). The CTO versus non-CTO 10-year survival was the same (71.2% vs. 71.4%, p = 0.9). Diabetics in the CTO cohort had a lower 10-year survival compared with nondiabetics (58.3% vs. 74.3%, p < 0.0001).
These data represent follow-up of the largest reported series of patients undergoing PCI for a CTO. The 10-year survival rates for matched non-CTO and the CTO cohorts were similar. Success rates have continued to improve without an accompanying increase in MACE rates. A successfully revascularized CTO confers a significant 10-year survival advantage compared with failed revascularization.
本研究比较了慢性冠状动脉完全闭塞（CTO）患者接受经皮冠状动脉介入治疗（PCI）与匹配的非CTO队列患者的手术结果和长期生存率，以确定成功的CTO PCI是否与生存率提高相关。
CTO的经皮冠状动脉介入治疗很常见，CTO PCI成功患者的长期生存率尚未明确界定。
在1980年6月至1999年12月期间，共有2007例连续患者接受了CTO的PCI治疗。利用倾向评分方法，确定了2007例匹配的非CTO队列患者并与CTO组进行比较。将队列分为手术成功和失败两组。
CTO队列的院内主要不良心脏事件（MACE）发生率为3.8%。在过去10年中，技术成功率有所提高（总体为74.4%，斜率为每年1.0%，p = 0.02，R2 = 49.9%），手术成功率也有所提高（总体为69.9%，斜率为每年1.2%，p = 0.02，R2 = 51.5%），而院内MACE发生率没有相应增加（斜率为每年0.1%，p = 0.7）。与CTO治疗失败相比，成功的CTO治疗具有明显的10年生存优势（73.5%对65.1%，p = 0.001）。CTO与非CTO的10年生存率相同（71.2%对71.4%，p = 0.9）。CTO队列中的糖尿病患者10年生存率低于非糖尿病患者（58.3%对74.3%，p < 0.0001）。
这些数据代表了已报道的接受CTO PCI治疗患者的最大系列随访。匹配的非CTO和CTO队列的10年生存率相似。成功率持续提高，而MACE发生率没有随之增加。与血管重建失败相比，成功进行血管重建的CTO具有显著的10年生存优势。
