Sanguineti Francesca, Garot Philippe, O'Connor Stephen, Watanabe Yusuke, Spaziano Marco, Lefèvre Thierry, Hovasse Thomas, Benamer Hakim, Unterseeh Thierry, Chevalier Bernard, Morice Marie-Claude, Louvard Yves
Hôpital Privé Jacques Cartier, Hôpital Privé Claude Galien, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay Générale de Santé, Massy, Quincy, France.
EuroIntervention. 2017 Feb 3;12(15):e1889-e1897. doi: 10.4244/EIJ-D-15-00278.
Despite technical advancements, long-term outcomes after chronic total occlusion (CTO) recanalisation remain a subject of debate, especially in diabetic patients. The aim of this study, therefore, was to assess the very long-term clinical outcome of diabetic vs. non-diabetic patients in a large cohort from a high-volume CTO PCI centre according to whether or not CTO recanalisation had been successfully achieved.
Between 2004 and 2012, 1,320 consecutive patients underwent PCI for CTO, 27.4% (362/1320) of whom were diabetics. We compared cardiac death, target lesion revascularisation (TLR), myocardial infarction (MI) and combined major adverse cardiac events (MACE) in patients with successful versus failed PCI (median follow-up 4.2 years). The PCI success rate was 75% (990/1,320 patients), with no significant differences between diabetics and non-diabetics (69.8% vs. 75%, respectively, p=0.07). Successful recanalisation was associated with lower cardiac death rates (13.2% vs. 17.2%, respectively, p<0.001) and lower MACE (27.5% vs. 33.7%, respectively, p=0.02). There were no significant differences in TLR (8.9% vs. 14.2% for failed recanalisation, p=0.29) and MI (4.7% vs. 10% for failed recanalisation). Successful recanalisation was a predictor of survival (HR 0.5, 95% CI: 0.32-0.81, p=0.005), whereas diabetes (HR 2.44, 95% CI: 1.52-3.83, p<0,001), left ventricular ejection fraction (HR 0.96, 95% CI: 0.94-0.99, p=0.004) and age (HR 1.06, 95% CI: 1.03-1.08, per year increment, p<0.0001) were predictors of cardiac death at follow-up. Cardiac mortality rates varied markedly after failed PCI between diabetic (20/103, 24.7%) and non-diabetic patients (15/227, 9.3%, p<0.0001 for comparison between groups), suggesting an interaction between the presence of diabetes and procedural outcome.
CTO recanalisation was associated with improved long-term survival, a reduced rate of MACE for up to nine years, and suggests a greater reduction in cardiac death among diabetic patients.
尽管技术不断进步，但慢性完全闭塞病变（CTO）再通后的长期预后仍是一个有争议的话题，尤其是在糖尿病患者中。因此，本研究的目的是在一个高容量CTO经皮冠状动脉介入治疗（PCI）中心的大型队列中，根据CTO再通是否成功，评估糖尿病患者与非糖尿病患者的极长期临床预后。
2004年至2012年期间，1320例连续患者接受了CTO的PCI治疗，其中27.4%（362/1320）为糖尿病患者。我们比较了PCI成功与失败患者（中位随访4.2年）的心源性死亡、靶病变血运重建（TLR）、心肌梗死（MI）和主要不良心脏事件（MACE）的联合发生率。PCI成功率为75%（990/1320例患者），糖尿病患者和非糖尿病患者之间无显著差异（分别为69.8%和75%，p = 0.07）。成功再通与较低的心源性死亡率（分别为13.2%和17.2%，p < 0.001）和较低的MACE发生率（分别为27.5%和33.7%，p = 0.02）相关。TLR（再通失败组为8.9% vs. 14.2%，p = 0.29）和MI（再通失败组为4.7% vs. 10%）无显著差异。成功再通是生存的预测因素（风险比[HR] 0.5，95%置信区间[CI]：0.32 - 0.81，p = 0.005），而糖尿病（HR 2.44，95% CI：1.52 - 3.83，p < 0.001）、左心室射血分数（HR 0.96，95% CI：0.94 - 0.99，p = 0.004）和年龄（HR 1.06，95% CI：1.03 - 1.08，每年增加，p < 0.0001）是随访时心源性死亡的预测因素。PCI失败后，糖尿病患者（20/103，24.7%）和非糖尿病患者（15/227，9.3%）的心源性死亡率差异显著（两组间比较p < 0.0001），提示糖尿病的存在与手术结果之间存在相互作用。
CTO再通与长期生存率提高、长达九年的MACE发生率降低相关，且提示糖尿病患者的心源性死亡降低幅度更大。
