Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Toronto, Ontario, Canada.
J Am Coll Cardiol. 2012 Mar 13;59(11):991-7. doi: 10.1016/j.jacc.2011.12.007.
The purpose of this study was to determine the prevalence, clinical characteristics, and management of coronary chronic total occlusions (CTOs) in current practice.
There is little evidence in contemporary literature concerning the prevalence, clinical characteristics, and treatment decisions regarding patients who have coronary CTOs identified during coronary angiography.
Consecutive patients undergoing nonurgent coronary angiography with CTO were prospectively identified at 3 Canadian sites from April 2008 to July 2009. Patients with previous coronary artery bypass graft surgery or presenting with acute ST-segment elevation myocardial infarction were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected.
Chronic total occlusions were identified in 1,697 (18.4%) patients with significant coronary artery disease (>50% stenosis in ≥1 coronary artery) who were undergoing nonemergent angiography. Previous history of myocardial infarction was documented in 40% of study patients, with electrocardiographic evidence of Q waves corresponding to the CTO artery territory in only 26% of cases. Left ventricular function was normal in >50% of patients with CTO. Half the CTOs were located in the right coronary artery. Almost half the patients with CTO were treated medically, and 25% underwent coronary artery bypass graft surgery (CTO bypassed in 88%). Percutaneous coronary intervention was done in 30% of patients, although CTO lesions were attempted in only 10% (with 70% success rate).
Chronic total occlusions are common in contemporary catheterization laboratory practice. Prospective studies are needed to ascertain the benefits of treatment strategies of these complex patients.
本研究旨在确定当前实践中冠状动脉慢性完全闭塞（CTO）的患病率、临床特征和治疗方法。
关于在冠状动脉造影中发现冠状动脉 CTO 的患者的患病率、临床特征和治疗决策，当代文献中证据甚少。
2008 年 4 月至 2009 年 7 月，3 个加拿大站点前瞻性地连续入选行非紧急冠状动脉造影且存在 CTO 的患者。排除先前接受过冠状动脉旁路移植术或伴有急性 ST 段抬高型心肌梗死的患者。收集详细的基线临床、血管造影、心电图和血运重建数据。
在 1697 例（18.4%）有明显冠状动脉疾病（≥1 支冠状动脉≥50%狭窄）的非紧急行造影的患者中发现 CTO。研究患者中有 40%有心肌梗死病史，只有 26%的病例有与 CTO 动脉区域相对应的心电图 Q 波证据。>50%的 CTO 患者的左心室功能正常。半数 CTO 位于右冠状动脉。近半数 CTO 患者接受药物治疗，25%行冠状动脉旁路移植术（88%的 CTO 旁路）。30%的患者行经皮冠状动脉介入治疗，但只有 10%尝试 CTO 病变（成功率为 70%）。
在当代导管室实践中，冠状动脉慢性完全闭塞很常见。需要前瞻性研究来确定这些复杂患者的治疗策略的益处。
