Prasad Abhiram, Rihal Charanjit S, Lennon Ryan J, Wiste Heather J, Singh Mandeep, Holmes David R
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
J Am Coll Cardiol. 2007 Apr 17;49(15):1611-1618. doi: 10.1016/j.jacc.2006.12.040. Epub 2007 Apr 2.
The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents.
The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice.
We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era).
Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25).
Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
我们研究的目的是通过一个单一的经皮冠状动脉介入治疗（PCI）登记系统，考察过去25年中慢性完全闭塞病变（CTO）经皮冠状动脉介入治疗后的手术成功率、住院及长期预后趋势，并考察药物洗脱支架的影响。
CTO的经皮治疗仍然是一项重大挑战。过去的研究对CTO使用了不同的定义，且当代实践中可用数据有限。
我们评估了梅奥诊所登记系统中1262例因CTO需要接受PCI的患者的预后。根据干预时间将患者分为4组：第1组（经皮腔内冠状动脉成形术时代）、第2组（早期支架时代）、第3组（裸金属支架时代）和第4组（药物洗脱支架时代）。
4组的手术成功率分别为51%、72%、73%和70%（p<0.001）。住院死亡率（2%、1%、0.4%和0%，p=0.009）、急诊冠状动脉搭桥术（15%、3%、2%和0.7%，p<0.001）以及主要不良心脏事件发生率（8%、5%、3%和4%，p=0.052）随时间下降。在随访期间，与之前治疗的患者相比，最近两个队列中死亡、心肌梗死或靶病变血运重建的联合终点显著更低（趋势p=0.001）。未能成功治疗CTO的技术因素不是长期死亡率的独立预测因素（风险比1.16[95%置信区间0.90至1.5]，p=0.25）。
在支架时代，CTO的手术成功率并未随时间提高，这突出表明需要开发新技术和设备。与支架植入前时代相比，住院期间主要不良心脏事件和1年靶血管血运重建率下降了约50%。
