原发性冠状动脉慢性完全闭塞患者经皮冠状动脉介入治疗的手术结果和长期生存率：20年经验

Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience.

作者信息

Suero J A, Marso S P, Jones P G, Laster S B, Huber K C, Giorgi L V, Johnson W L, Rutherford B D

机构信息

Mid-America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA.

出版信息

J Am Coll Cardiol. 2001 Aug;38(2):409-14. doi: 10.1016/s0735-1097(01)01349-3.

DOI:10.1016/s0735-1097(01)01349-3

PMID:11499731

Abstract

OBJECTIVES

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.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

背景

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。

方法

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。

结果

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）。