Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
JACC Cardiovasc Interv. 2016 Mar 28;9(6):530-8. doi: 10.1016/j.jcin.2015.11.016. Epub 2016 Mar 2.
The purpose of this study was to evaluate long-term clinical outcomes after drug-eluting stent-supported percutaneous coronary intervention (PCI) for native coronary total occlusion (CTO).
The benefit of successful recanalization of CTO on prognosis remains uncertain.
Between March 2003 and May 2014, 1,173 consecutive patients with CTO of native coronary vessels requiring PCI were enrolled. Drug-eluting stent implantation was performed in all successful procedures (1,004 patients, 85.6%).
During a median follow-up of 4.6 years, the adjusted risks of all-cause mortality (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 0.53 to 2.04; p = 0.92) and the composite of death or myocardial infarction (HR: 1.05; 95% CI: 0.56 to 1.94; p = 0.89) were found to be comparable between patients with successful and failed CTO-PCI, whereas the adjusted risk of target vessel revascularization (HR: 0.15; 95% CI: 0.10 to 0.25; p < 0.001) and coronary artery bypass grafting (HR: 0.02; 95% CI: 0.006 to 0.06, p < 0.001) was significantly higher in patients with failed CTO-PCI. Among patients (n = 879) in whom complete revascularization for non-CTO vessels was performed, the risk of death or the composite of death or myocardial infarction were not found to differ between patients who underwent successful recanalization of the remaining CTO and patients who did not. This finding was consistent regardless of whether the patient had a multivessel disease including CTO or only had a single CTO disease.
Successful CTO-PCI compared with failed PCI was not associated with a lesser risk for mortality. However, successful CTO-PCI was associated with significantly less subsequent coronary artery bypass grafting.
本研究旨在评估药物洗脱支架支持下经皮冠状动脉介入治疗（PCI）治疗原发性冠状动脉完全闭塞（CTO）的长期临床结果。
CTO 再通对预后的益处仍不确定。
2003 年 3 月至 2014 年 5 月，连续纳入 1173 例需要 PCI 的原发性冠状动脉 CTO 患者。所有成功的手术（1004 例患者，85.6%）均行药物洗脱支架植入术。
在中位随访 4.6 年期间，调整后的全因死亡率（风险比[HR]：1.04；95%置信区间[CI]：0.53 至 2.04；p=0.92）和死亡或心肌梗死复合终点（HR：1.05；95%CI：0.56 至 1.94；p=0.89）的风险在 CTO-PCI 成功和失败的患者之间无差异，而靶血管血运重建（HR：0.15；95%CI：0.10 至 0.25；p<0.001）和冠状动脉旁路移植术（HR：0.02；95%CI：0.006 至 0.06；p<0.001）的风险在 CTO-PCI 失败的患者中显著更高。在（n=879）进行非 CTO 血管完全血运重建的患者中，无论剩余 CTO 是否成功再通，成功再通患者与未成功再通患者的死亡或死亡或心肌梗死复合终点风险均无差异。无论患者是否患有多血管疾病（包括 CTO）或仅患有单支 CTO 疾病，这一发现都是一致的。
与 PCI 失败相比，CTO-PCI 成功并不与死亡率降低相关。然而，CTO-PCI 成功与随后的冠状动脉旁路移植术显著减少相关。
