Safley David M, Grantham J Aaron, Hatch Jason, Jones Philip G, Spertus John A
Mid America Heart Institute, Division of Cardiovascular Research, St. Luke's Hospital, Kansas City, Missouri; Division of Cardiology, University of Missouri, Kansas City, Missouri.
Catheter Cardiovasc Interv. 2014 Oct 1;84(4):629-34. doi: 10.1002/ccd.25303. Epub 2013 Dec 19.
We aimed to compare quality of life benefits of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) with non-CTO PCI.
Data quantifying the benefits of PCI of CTO are inconsistent.
We leveraged a 10-center prospective PCI registry including Seattle Angina Questionnaire (SAQ) assessment at the time of PCI and in follow-up. We propensity matched attempted CTO PCIs with up to 10 non-CTO PCIs. The primary analysis compared changes between baseline and 6 months in SAQ Physical Limitation (PL), Quality of Life (QoL); Angina Frequency (AF) scores as well as the Rose Dyspnea scores (RDS) and the EQ5D Visual Analogue Scale (VAS). Noninferiority was assessed for quality of life changes between CTO and non-CTO PCI.
In 3,303 patients enrolled, 167 single-vessel CTOs were attempted; 147 (88%) were matched with 1,616 non-CTO PCI. Baseline PL (73.0 vs. 77.4, P = 0.039) and VAS (66.4 vs. 70.8, P = 0.005) scores were lower for CTO. There was no difference in AF, QoL, or RDS scores. At 6-month follow-up, all SAQ scores improved (P < 0.05 vs. baseline for all) and were equivalent for CTO and Non-CTO (P = NS for all). VAS scores remained lower for CTO, but improved in both groups (P < 0.05 vs. baseline for both). Formal noninferiority testing demonstrated that CTO PCI was not inferior to non-CTO PCI (P ≤ 0.02 for all).
Symptoms, function, QoL, and dyspnea improve to the same degree following CTO PCI as compared with non-CTO PCI. Symptom relief supports CTO PCI to improve patients' quality of life.
我们旨在比较经皮冠状动脉介入治疗（PCI）对慢性完全闭塞病变（CTO）与非CTO病变患者生活质量的改善情况。
量化CTO病变PCI获益的数据并不一致。
我们利用了一个10中心前瞻性PCI注册研究，其中包括在PCI时及随访时进行西雅图心绞痛问卷（SAQ）评估。我们采用倾向评分匹配法，将尝试进行CTO PCI的患者与最多10例非CTO PCI患者进行匹配。主要分析比较了基线与6个月时SAQ身体限制（PL）、生活质量（QoL）、心绞痛发作频率（AF）评分以及罗斯呼吸困难评分（RDS）和EQ5D视觉模拟量表（VAS）的变化。对CTO与非CTO PCI患者生活质量变化进行非劣效性评估。
在纳入的3303例患者中，尝试对167例单支血管CTO病变进行治疗；其中147例（88%）与1616例非CTO PCI患者进行了匹配。CTO患者的基线PL（73.0对77.4，P = 0.039）和VAS（66.4对70.8，P = 0.005）评分较低。AF、QoL或RDS评分无差异。在6个月随访时，所有SAQ评分均有所改善（与基线相比，P均<0.05），且CTO与非CTO患者相当（所有P = 无显著性差异）。CTO患者的VAS评分仍较低，但两组均有改善（与基线相比，P均<0.05）。正式的非劣效性检验表明，CTO PCI不劣于非CTO PCI（所有P≤0.02）。
与非CTO PCI相比，CTO PCI后症状、功能、QoL和呼吸困难的改善程度相同。症状缓解支持CTO PCI可改善患者生活质量。
