右冠状动脉慢性完全闭塞对行经皮冠状动脉介入治疗的无保护左主干病变患者临床结局的影响。

The impact of right coronary artery chronic total occlusion on clinical outcome of patients undergoing percutaneous coronary intervention for unprotected left main disease.

机构信息

Division of Cardiology, Careggi Hospital, Florence, Italy.

出版信息

J Am Coll Cardiol. 2011 Jul 5;58(2):125-30. doi: 10.1016/j.jacc.2011.02.050.

DOI:10.1016/j.jacc.2011.02.050

PMID:21718907

Abstract

OBJECTIVES

The aim of the present study was to investigate whether right coronary artery chronic total occlusion (CTO) carries prognostic implications in patients undergoing drug-eluting stent-supported percutaneous coronary intervention (PCI) for unprotected left main disease (ULMD).

BACKGROUND

No data exist on the prognostic implication of CTO in patients undergoing PCI for ULMD.

METHODS

Prospective registry of consecutive patients undergoing PCI for ULMD. Patients with ST-segment elevation myocardial infarction were excluded. Primary endpoints were 6-month and long-term cardiac mortality.

RESULTS

From January 2004 to December 2009, 330 patients underwent PCI for ULMD. Of the 330 patients, 78 (24%) had CTO of the right coronary artery, 22 (7%) had CTO of the left anterior descending artery, and 16 (5%) had CTO of the left circumflex artery. Patients with right coronary artery CTO had a higher risk profile compared with patients without right coronary artery CTO. The 6-month mortality rate was 12.8% in patients with right coronary artery CTO, and 3.6% in patients without right coronary artery CTO (p < 0.002), and the 3-year cardiac survival rate was 76.4 ± 6.8% and 89.7 ± 2.7% (p < 0.003), respectively. By multivariable analysis, the only 2 independent predictors of 3-year cardiac mortality were right coronary artery CTO (hazard ratio: 2.15, 95% confidence interval: 1.02 to 4.50; p = 0.043) and EuroSCORE (hazard ratio: 1.03, 95% confidence interval: 1.02 to 1.05; p < 0.001).

CONCLUSIONS

Right coronary artery CTO occurs frequently and is a significant predictor of mortality in patients with ULMD undergoing PCI.

摘要

目的

本研究旨在探讨右冠状动脉慢性完全闭塞（CTO）是否对行经皮冠状动脉介入治疗（PCI）的无保护左主干病变（ULMD）患者具有预后意义。

背景

目前尚无关于 CTO 对接受 ULMD PCI 治疗的患者的预后影响的数据。

方法

前瞻性连续登记接受 ULMD PCI 的患者。排除 ST 段抬高型心肌梗死患者。主要终点为 6 个月和长期心脏死亡率。

结果

2004 年 1 月至 2009 年 12 月，330 例患者接受 ULMD PCI。330 例患者中，78 例（24%）存在右冠状动脉 CTO，22 例（7%）存在左前降支 CTO，16 例（5%）存在左回旋支 CTO。右冠状动脉 CTO 患者的风险状况高于无右冠状动脉 CTO 患者。右冠状动脉 CTO 患者的 6 个月死亡率为 12.8%，无右冠状动脉 CTO 患者为 3.6%（p < 0.002），3 年心脏生存率分别为 76.4 ± 6.8%和 89.7 ± 2.7%（p < 0.003）。多变量分析显示，3 年心脏死亡率的唯一 2 个独立预测因素是右冠状动脉 CTO（风险比：2.15，95%置信区间：1.02 至 4.50；p = 0.043）和 EuroSCORE（风险比：1.03，95%置信区间：1.02 至 1.05；p < 0.001）。