Cardiovascular Diseases, The Wright Center for Graduate Medical Education and Medicine, The Commonwealth Medical College, Scranton, Pennsylvania, USA.
Am J Cardiol. 2013 Feb 15;111(4):521-5. doi: 10.1016/j.amjcard.2012.10.034.
We performed a systematic review and meta-analysis comparing the all-cause mortality outcomes of successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) with unsuccessful CTO-PCI, using a stent-based strategy. Multiple studies comparing successful CTO-PCI with unsuccessful CTO-PCI have reported variable outcomes. No systematic review or meta-analysis has been performed after stenting became the default strategy for CTO-PCI. Searching major electronic databases, 64 studies were identified using the keywords "CTO," "PCI," and "mortality." Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method, 13 studies met the criteria for inclusion in the present meta-analysis. The short-term (≤30 days) and long-term (≥1 year) mortality outcomes were analyzed comparing successful CTO-PCI and unsuccessful CTO-PCI. Coronary perforation and its association with CTO-PCI success was analyzed. A significant reduction in short-term mortality was noted with successful CTO-PCI compared to unsuccessful CTO-PCI (odds ratio 0.218, 95% confidence interval 0.095 to 0.498, Z = -3.61, p <0.001). A similar, significant reduction in long-term mortality was noted with successful CTO-PCI compared to unsuccessful CTO-PCI (odds ratio 0.391, 95% confidence interval 0.311 to 0.493, Z = -7.957, p <0.001). A significant association was present between coronary perforation and unsuccessful CTO-PCI (odds ratio 0.168, 95% confidence interval 0.104 to 0.271, Z = -7.333, p <0.001). In conclusion, successful CTO-PCI using a predominantly stent-based strategy is associated with a significant reduction in short- and long-term mortality compared to unsuccessful CTO-PCI. Coronary perforation was associated with CTO-PCI failure.
我们进行了一项系统评价和荟萃分析，比较了使用支架为基础的策略对慢性完全闭塞（CTO）进行成功经皮冠状动脉介入治疗（PCI）与不成功 CTO-PCI 的全因死亡率结果。比较成功 CTO-PCI 与不成功 CTO-PCI 的多项研究报告了不同的结果。在支架成为 CTO-PCI 的默认策略后，尚未进行系统评价或荟萃分析。通过搜索主要电子数据库，使用“CTO”、“PCI”和“死亡率”等关键词，确定了 64 项研究。使用系统评价和荟萃分析的首选报告项目方法，有 13 项研究符合纳入本荟萃分析的标准。分析比较了成功 CTO-PCI 和不成功 CTO-PCI 的短期（≤30 天）和长期（≥1 年）死亡率结果。还分析了冠状动脉穿孔及其与 CTO-PCI 成功的关系。与不成功的 CTO-PCI 相比，成功的 CTO-PCI 可显著降低短期死亡率（比值比 0.218，95%置信区间 0.095 至 0.498，Z=-3.61，p<0.001）。与不成功的 CTO-PCI 相比，成功的 CTO-PCI 也可显著降低长期死亡率（比值比 0.391，95%置信区间 0.311 至 0.493，Z=-7.957，p<0.001）。冠状动脉穿孔与不成功的 CTO-PCI 之间存在显著相关性（比值比 0.168，95%置信区间 0.104 至 0.271，Z=-7.333，p<0.001）。总之，与不成功的 CTO-PCI 相比，使用主要支架为基础的策略对 CTO 进行成功 PCI 与短期和长期死亡率的显著降低相关。冠状动脉穿孔与 CTO-PCI 失败相关。
