Li Ruogu, Yang Shuansuo, Tang Lei, Yang Yiqing, Chen Hui, Guan Shaofeng, Han Wenzheng, Liu Hua, Dai Jinjie, Gan Qian, Fang Weiyi, Qu Xinkai
Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, NO,241, Huaihai Xi Road, Xuhui District, Shanghai 200030, China.
J Cardiothorac Surg. 2014 Feb 28;9:41. doi: 10.1186/1749-8090-9-41.
Coronary chronic total occlusion (CTO) is the last stage of coronary artery atherosclerosis. Percutaneous coronary intervention (PCI) is a therapeutic procedure used to recanalize vessels with total occlusion. However, successful recanalization of CTO is still not optimal, and the key influence factors are still uncertainty. Therefore, a scientific evaluation on the effective of PCI for CTO treatment is necessary.
Relevant studies of PCI treatment for CTO were examined. Data were extracted and assessed by two independent clinical experts. Embase, PubMed and Medline et al. were used as database. The main research key words include "CTO", "PCI", "Stent", "Reopen", "long-term", "follow-up" and "outcome". Quality assessment was carried out according to the Cochrane Handbook. The selected data were pooled and analyzed using fixed-effect model and random-effect model. Heterogeneity was assessed using the I(2) test, Q test, L'abbe and Galbraith. Comprehensive Meta -Analysis 2.0 and Metanalysis 1.0 were used for statistics analysis in this research.
A total of 16 articles involving 6695 cases in successful CTO recanalization (CTO success group) and 2370 cases in failed CTO recanalization(CTO failure group) were included in this research. Low CTO success was associated with elder age, previous coronary artery bypass graft surgery (CABG) history, multi-vessel diseases and right coronary artery disease lesion. Six follow-up variables including major adverse cardiac events (MACE), recurrent myocardial infarction (MI), all-cause death, incidence of angina, subsequent CABG and cumulative survival rate were found significantly reduced associated with CTO success.
Clinical baseline characteristics such as age, previous CABG history and lesion baseline characteristics such as lesion length, multi-vessel diseases might be important factors influencing the successful rate of CTO recanalization. Compared to CTO failure patients, all six follow-up variables showed advantage for CTO success patients.
冠状动脉慢性完全闭塞（CTO）是冠状动脉粥样硬化的终末阶段。经皮冠状动脉介入治疗（PCI）是用于使完全闭塞血管再通的一种治疗手段。然而，CTO的成功再通仍不理想，关键影响因素尚不明确。因此，有必要对PCI治疗CTO的有效性进行科学评估。
检索关于CTO的PCI治疗的相关研究。由两名独立的临床专家提取并评估数据。使用Embase、PubMed和Medline等作为数据库。主要研究关键词包括“CTO”“PCI”“支架”“再通”“长期”“随访”和“结局”。根据Cochrane手册进行质量评估。使用固定效应模型和随机效应模型对所选数据进行汇总和分析。使用I(2)检验、Q检验、L'abbe和Galbraith评估异质性。本研究使用Comprehensive Meta -Analysis 2.0和Metanalysis 1.0进行统计分析。
本研究共纳入16篇文章，其中成功实现CTO再通的有6695例（CTO成功组），CTO再通失败的有2370例（CTO失败组）。CTO成功率低与高龄、既往冠状动脉旁路移植术（CABG）史、多支血管病变和右冠状动脉病变相关。发现包括主要不良心脏事件（MACE）、再发心肌梗死（MI）、全因死亡、心绞痛发生率、后续CABG和累积生存率在内的六个随访变量与CTO成功显著降低相关。
年龄、既往CABG史等临床基线特征以及病变长度、多支血管病变等病变基线特征可能是影响CTO再通成功率的重要因素。与CTO失败患者相比，六个随访变量对CTO成功患者均显示出优势。
