Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Cardiol. 2013 Sep 15;112(6):767-74. doi: 10.1016/j.amjcard.2013.05.004. Epub 2013 Jun 1.
Despite improving success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still a matter of debate. Of 13,087 patients who underwent PCI in the CREDO-Kyoto registry cohort-2, 1,524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared between 1,192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI. In-hospital death tended to occur less frequently in the successful CTO-PCI group than in the failed CTO-PCI group (1.4% vs 3.0%, p = 0.053). Through 3-year follow-up, the cumulative incidence of all-cause death was not significantly different between the successful and failed CTO-PCI groups (9.0% vs 13.1%, p = 0.18), whereas the cumulative incidence of cardiac death was significantly less in the successful CTO-PCI group than in the failed CTO-PCI group (4.5% vs 8.4%, p = 0.03). However, after adjusting confounders, successful CTO-PCI was associated with lesser risk for neither all-cause death (hazard ratio 0.93, 95% confidence interval 0.64 to 1.37, p = 0.69) nor cardiac death (hazard ratio 0.71, 95% confidence interval 0.44 to 1.16, p = 0.16). The cumulative incidence of coronary artery bypass grafting (CABG) was remarkably less in patients with successful PCI compared with those with failed PCI (1.8% vs 19.6%, p <0.0001). In conclusion, successful CTO-PCI compared with failed PCI was not associated with lesser risk for 3-year mortality. However, successful CTO-PCI was associated with significantly less subsequent CABG.
尽管经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）病变的成功率有所提高，但 CTO 再通的临床获益仍存在争议。在 CREDO-Kyoto 注册队列-2 中，13087 例接受 PCI 的患者中，有 1524 例接受 CTO-PCI。比较了 1192 例 CTO-PCI 成功患者和 332 例 CTO-PCI 失败患者的临床结局。住院期间，成功 CTO-PCI 组的死亡率低于 CTO-PCI 失败组（1.4% vs. 3.0%，p=0.053）。在 3 年随访期间，成功 CTO-PCI 组和 CTO-PCI 失败组的全因死亡率无显著差异（9.0% vs. 13.1%，p=0.18），但成功 CTO-PCI 组的心脏性死亡率显著低于 CTO-PCI 失败组（4.5% vs. 8.4%，p=0.03）。然而，调整混杂因素后，成功 CTO-PCI 与全因死亡风险降低无关（风险比 0.93，95%置信区间 0.64 至 1.37，p=0.69）或心脏性死亡风险降低无关（风险比 0.71，95%置信区间 0.44 至 1.16，p=0.16）。与 CTO-PCI 失败患者相比，成功 PCI 患者的冠状动脉旁路移植术（CABG）累积发生率显著降低（1.8% vs. 19.6%，p<0.0001）。总之，与 CTO-PCI 失败相比，成功 CTO-PCI 与 3 年死亡率降低无关。然而，成功 CTO-PCI 与随后 CABG 的发生率显著降低有关。
