Institute of Cardiology, Sacro Cuore Catholic University, Rome, Italy.
Am J Cardiol. 2012 Oct 1;110(7):948-53. doi: 10.1016/j.amjcard.2012.05.025. Epub 2012 Jun 19.
The success rate of recanalization of coronary chronic total occlusion (CTO) has improved in recent years, but the clinical benefit associated with successful CTO recanalization in the drug-eluting stent (DES) era is not well known. A cohort of 317 consecutive patients (mean age 65 ± 10, 84% men) with CTOs (defined as Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 and duration >3 months) of native coronary vessels in which percutaneous coronary intervention was attempted was enrolled from June 2005 to March 2009. All successful procedures (196 patients) were performed by DES implantation. The incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and repeat revascularization) was assessed during a mean follow-up period of 3 years. MACE predictors were assessed in clinical, angiographic, and procedural data, including procedural success. Patients with successful percutaneous coronary intervention experienced a significantly lower MACE rate compared to those with failed procedures (17 [9%] vs 32 [26%], p = 0.008). Patients with multivessel disease experienced MACEs more frequently than those with single-vessel disease (45 [22%] vs 4 [4%], p = 0.002). On multiple Cox regression analysis, the presence of multivessel disease and CTO opening failure were independent predictors of MACEs (hazard ratio 2.31, 95% confidence interval 1.17 to 4.96, p = 0.01, and hazard ratio 1.81, 95% confidence interval 1.33 to 4.12, p = 0.02, respectively). The worst prognosis was confined to patients with multivessel disease and failed procedures (hazard ratio 2.73, 95% confidence interval 1.21 to 3.92, p = 0.03). In conclusion, successful recanalization of CTOs with DES translates into a reduction of the 3-year MACE rate compared to failed procedures, and the worst prognosis is observed in patients with failed procedures and multivessel disease, a notion that might be taken into account in the management of patients with coronary CTOs.
近年来，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞病变（CTO）的成功率有所提高，但在药物洗脱支架（DES）时代，成功开通 CTO 与临床获益之间的关系尚不清楚。2005 年 6 月至 2009 年 3 月，连续入选了 317 例（平均年龄 65 ± 10 岁，84%为男性）有 CTO（定义为血栓溶解心肌梗死 [TIMI]血流分级 0 级和持续时间＞3 个月）的患者，这些患者的病变均为原发性冠状动脉血管，并且对这些患者尝试了 PCI。所有成功的手术（196 例）均采用 DES 植入术。在平均 3 年的随访期间，评估了主要不良心脏事件（MACE；包括心源性死亡、心肌梗死和再次血运重建的复合终点）的发生率。在临床、血管造影和手术数据（包括手术成功率）中评估了 MACE 的预测因素。与手术失败的患者相比，手术成功的患者 MACE 发生率显著降低（17 例[9%] vs 32 例[26%]，p = 0.008）。多支血管病变患者的 MACE 发生率明显高于单支血管病变患者（45 例[22%] vs 4 例[4%]，p = 0.002）。多因素 Cox 回归分析显示，多支血管病变和 CTO 开通失败是 MACE 的独立预测因素（风险比 2.31，95%置信区间 1.17 至 4.96，p = 0.01，和风险比 1.81，95%置信区间 1.33 至 4.12，p = 0.02）。预后最差的仅限于多支血管病变和手术失败的患者（风险比 2.73，95%置信区间 1.21 至 3.92，p = 0.03）。总之，与手术失败相比，用 DES 开通 CTO 可降低 3 年 MACE 发生率，而在手术失败和多支血管病变的患者中预后最差，这一概念可能会在 CTO 患者的治疗中得到考虑。
