Hoebers Loes P, Claessen Bimmer E, Elias Joelle, Dangas George D, Mehran Roxana, Henriques José P S
Academic Medical Center, University of Amsterdam, The Netherlands.
Mount Sinai Medical Center, New York, NY, United States.
Int J Cardiol. 2015;187:90-6. doi: 10.1016/j.ijcard.2015.03.164. Epub 2015 Mar 17.
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) may have a beneficial effect on survival through a better-preserved or improved LVEF. Current literature consists of small observational studies therefore we performed a weighted meta-analysis on the impact of revascularization of CTOs on left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and long-term mortality.
We conducted a meta-analysis evaluating LVEF before and after CTO PCI and long-term mortality. No language or time restrictions were applied. References from the identified articles and reviews were examined to find additional relevant manuscripts.
Of the 812 citations, 34 studies performed between 1987-2014 in 2243 patients were eligible for LVEF and 27 studies performed between 1990-2013 in 11,085 patients with success and 4347 patients that failed CTO PCI were eligible for long-term mortality. After successful CTO PCI, LVEF increased with 4.44% (95% CI: 3.52-5.35, p<0.01) compared to baseline. In a small cohort of ~70 patients, no significant difference in LVEF was observed after non-successful CTO PCI or reocclusion. Additionally, 8 studies reported the change in left ventricular end-diastolic volume (LVEDV) in a total of 412 patients. LVEDV decreased with 6.14 ml/m(2) (95% CI: -9.31 to -2.97, p<0.01). Successful CTO PCI was also associated with reduced mortality in comparison with failed CTO PCI (OR: 0.52, 95% CI: 0.43-0.62, p-value<0.01).
The current meta-analysis revealed that successful recanalization of a CTO resulted in an overall improvement of 4.44% absolute LVEF points, reduced adverse remodeling and an improvement of survival (OR: 0.52).
慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）可能通过更好地保留或改善左心室射血分数（LVEF）对生存产生有益影响。目前的文献由小型观察性研究组成，因此我们对CTO血管重建对左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）和长期死亡率的影响进行了加权荟萃分析。
我们进行了一项荟萃分析，评估CTO PCI前后的LVEF和长期死亡率。未应用语言或时间限制。检查已识别文章和综述中的参考文献以查找其他相关手稿。
在812篇引用文献中，1987年至2014年期间对2243例患者进行的34项研究符合LVEF分析标准，1990年至2013年期间对11085例CTO PCI成功患者和4347例失败患者进行的27项研究符合长期死亡率分析标准。CTO PCI成功后，与基线相比，LVEF增加了4.44%（95%CI：3.52-5.35，p<0.01）。在一个约70例患者的小队列中，CTO PCI未成功或再闭塞后未观察到LVEF有显著差异。此外，8项研究报告了总共412例患者的左心室舒张末期容积（LVEDV）变化。LVEDV减少了6.14 ml/m²（95%CI：-9.31至-2.97，p<0.01）。与CTO PCI失败相比，CTO PCI成功还与死亡率降低相关（OR：0.52，95%CI：0.43-0.62，p值<0.01）。
当前的荟萃分析表明，CTO成功再通导致绝对LVEF总体改善4.44个百分点，减少不良重塑并改善生存（OR：0.52）。
