Hwang Ji-Won, Yang Jeong Hoon, Choi Seung-Hyuk, Hwang Jin Kyung, Jang Woo Jin, Hahn Joo-Yong, Song Young Bin, Choi Jin-Ho, Lee Sang Hoon, Gwon Hyeon-Cheol
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2016 May 1;210:56-62. doi: 10.1016/j.ijcard.2016.02.084. Epub 2016 Feb 16.
To compare clinical outcomes of percutaneous coronary intervention (PCI) with those of optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery.
Limited data are available on the efficacy of OMT for the treatment of single-vessel CTO.
Between March 2003 and February 2012, we enrolled 2024 CTO patients in a retrospective, observational registry and analyzed 435 patients with CTO of a single coronary artery. We divided patients into an OMT group (n=147) and PCI group (n=288) according to the initial treatment strategy. One-to-many (1:N) propensity score matching with a non-fixed matching ratio was also performed. The primary outcome measured in this study was major adverse cardiac events (MACEs) including cardiac death, myocardial infarction, and repeated coronary revascularization.
The median follow-up duration was 47.6 (interquartile range: 22.9 to 68.9) months. Major adverse cardiac events were noted for 16 patients (10.9%) in the OMT group compared to 41 patients (14.2%) in the PCI group (p=0.38). After propensity-score matching, there were no significant differences between the OMT group and PCI group with respect to MACE frequency (10.1% vs. 16.9%, adjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 0.88-4.68, p=0.10) or cardiac death (OMT vs. PCI: 5.1% vs. 4.8%, HR, 1.14; 95% CI, 0.30-4.42, p=0.85). Subgroup analysis showed that the rate of MACEs was significantly lower in the OMT group compared to the PCI group among patients with an APPROACH score ≤ 18 and SYNTAX score ≤ 12.
As a treatment strategy in patients with single-vessel CTO, PCI did not reduce the risk of MACE or cardiac death. These results suggest that OMT may be a better initial strategy for patients as assessed by low APPROACH and SYNTAX scores.
比较单支冠状动脉慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）与单纯最佳药物治疗（OMT）的临床结局。
关于OMT治疗单支血管CTO疗效的数据有限。
在2003年3月至2012年2月期间，我们将2024例CTO患者纳入一项回顾性观察登记研究，并分析了435例单支冠状动脉CTO患者。根据初始治疗策略，我们将患者分为OMT组（n = 147）和PCI组（n = 288）。还进行了非固定匹配比例的一对一（1:N）倾向评分匹配。本研究测量的主要结局是主要不良心脏事件（MACE），包括心源性死亡、心肌梗死和再次冠状动脉血运重建。
中位随访时间为47.6（四分位间距：22.9至68.9）个月。OMT组有16例患者（10.9%）发生主要不良心脏事件，而PCI组有41例患者（14.2%）发生（p = 0.38）。倾向评分匹配后，OMT组和PCI组在MACE发生率（10.1%对16.9%，调整后风险比[HR]，2.03；95%置信区间[CI]，0.88 - 4.68，p = 0.10）或心源性死亡方面（OMT对PCI：5.1%对4.8%，HR，1.14；95%CI，0.30 - 4.42，p = 0.85）无显著差异。亚组分析显示，在APPROACH评分≤18且SYNTAX评分≤12的患者中，OMT组的MACE发生率显著低于PCI组。
作为单支血管CTO患者的治疗策略，PCI并未降低MACE或心源性死亡风险。这些结果表明，对于经低APPROACH和SYNTAX评分评估的患者，OMT可能是更好的初始策略。
