Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York 10029, USA.
JACC Cardiovasc Interv. 2011 Sep;4(9):952-61. doi: 10.1016/j.jcin.2011.03.021.
The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO.
We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years).
Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes.
Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.
本研究旨在评估慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）后的长期临床结果。
尽管技术不断进步，但关于 CTO 经 PCI 后的长期结果的数据仍然很少。
我们评估了 1998 年至 2007 年间在美国、韩国和意大利的 3 家三级护理中心接受 1852 例 CTO 经 PCI 治疗的 1791 例患者的长期临床结果。中位随访时间为 2.9 年（四分位间距：1.5 至 4.6 年）。
1226 例（68%）患者获得了手术成功。1160 例患者（95%）植入了支架；396 例患者（34%）接受了裸金属支架（BMS）治疗，764 例患者（66%）接受了药物洗脱支架（DES）治疗。多变量分析后，成功的 CTO PCI 是心脏死亡率降低的独立预测因素（风险比[HR]：0.40，95%置信区间[CI]：0.21 至 0.75，p<0.01）和减少冠状动脉旁路移植术的需要（HR：0.21，95%CI：0.13 至 0.40，p<0.01）；它还与 5 年随访时全因死亡率的下降趋势相关（HR：0.63，95%CI：0.40 至 1.00，p=0.05）。在接受支架植入的患者中，DES 治疗而非 BMS 治疗可降低长期随访时的靶血管血运重建率（17.2%对 31.1%，p<0.01）；确定/可能的支架血栓形成率相似（DES 1.7%，BMS 2.3%，p=0.58）。在 DES 亚组中，接受紫杉醇洗脱支架和西罗莫司洗脱支架治疗的患者具有相似的临床结局。
成功的 CTO PCI 与降低长期心脏死亡率和冠状动脉旁路移植术的需要相关。与 BMS 相比，用 DES 治疗 CTO 与靶血管血运重建显著减少相关，支架血栓形成率相似。紫杉醇洗脱支架和西罗莫司洗脱支架具有相似的长期安全性和疗效。
