Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze.
JACC Cardiovasc Interv. 2016 Sep 12;9(17):1790-7. doi: 10.1016/j.jcin.2016.06.007.
This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy.
The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed.
The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint.
Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (-CTO). The 12-month mortality for the +CTO and -CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006).
Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.
本研究旨在评估慢性完全闭塞（CTO）对缺血性心肌病患者长期预后的影响。
急性冠脉综合征中，非罪犯病变合并 CTO 与预后较差相关。冠心病是心力衰竭的主要病因，在许多情况下至少会观察到 1 处 CTO。
本研究纳入了所有 2009 年 1 月至 2014 年 12 月期间在正在进行的单中心 COMMIT-HF（Contemporary Modalities In Treatment of Heart Failure）注册研究（NCT02536443）中接受选择性冠状动脉造影且存在收缩性心力衰竭的患者。根据 CTO 存在情况将患者分为 2 组。所有分析患者的随访时间均至少 12 个月，以全因死亡率为主要终点。
在符合纳入和排除标准的 675 例患者中，278 例（41.2%）患者至少存在 1 处主要冠状动脉 CTO（+CTO），397 例（58.8%）患者未观察到 CTO（-CTO）。+CTO 和 -CTO 患者的 12 个月死亡率分别为 19.4%和 10.3%（p<0.001），24 个月时也存在差异（26.6% vs. 17.6%；p=0.01）。在对基线特征差异进行多变量调整后，CTO 的存在仍与较高的 12 个月死亡率显著相关（相对风险：1.84：95%置信区间：1.18 至 2.85；p=0.006）。
我们的分析表明，在缺血性心力衰竭患者中，CTO 的存在与较差的长期预后相关。
