Monash Heart, Melbourne, Australia.
Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri Kansas City, Kansas City, Missouri.
JACC Cardiovasc Interv. 2017 Aug 14;10(15):1523-1534. doi: 10.1016/j.jcin.2017.05.065.
This study sought to accurately describe the success rate, risks, and patient-reported benefits of contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
In light of the evolving techniques to successfully revascularize CTO lesions, there remains a compelling need to more accurately quantify the success rates, risks, and benefits of these complex procedures.
Using a uniquely comprehensive, core-lab adjudicated, single-arm, multicenter registry of 1,000 consecutive patients undergoing CTO PCI by the hybrid approach, we evaluated the technical success rates, complication rates, and raw and adjusted health status benefits at 1 month among successfully as compared to unsuccessfully treated patients.
Technical success was high (86%). In-hospital and 1-month mortality was 0.9% and 1.3%, respectively, and perforations requiring treatment occurred in 48 patients (4.8%). Among those who survived and completed the 1-month interview (n = 947), mean ± SEM Seattle Angina Questionnaire quality of life scores improved from 49.4 ± 0.9 to 75.0 ± 0.7 (p < 0.01), mean Rose Dyspnea Scale scores improved (decreased) from 2.0 ± 0.1 to 1.1 ± 0.1 (p < 0.01), and physician health questionnaire (for depression) scores improved (decreased) from 6.2 ± 0.2 to 3.5 ± 0.1 (p < 0.01) at 1 month. After adjusting for baseline differences the mean group difference in Seattle Angina Questionnaire quality of life between successful and unsuccessful CTO PCI was 10.8 (95% confidence interval: 6.3 to 15.3; p < 0.001).
Clarifying the success rates, risks, and benefits of CTO PCI will help to more accurately contextualize the informed consent process for these procedures so that patients with appropriate indications for CTO PCI can more effectively share in the decision to pursue this or other therapeutic options.
本研究旨在准确描述当代慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成功率、风险和患者报告的获益。
鉴于成功血运重建 CTO 病变的技术不断发展，仍然迫切需要更准确地量化这些复杂手术的成功率、风险和获益。
使用独特的全面、核心实验室裁决、单臂、多中心登记处的 1000 例连续接受杂交方法 CTO PCI 的患者，我们评估了技术成功率、并发症发生率以及在成功治疗与未成功治疗的患者中，1 个月时的原始和调整后的健康状况获益。
技术成功率高（86%）。住院期间和 1 个月死亡率分别为 0.9%和 1.3%，48 例（4.8%）发生需要治疗的穿孔。在存活并完成 1 个月访谈的患者中（n=947），西雅图心绞痛问卷生活质量评分从 49.4±0.9 提高到 75.0±0.7（p<0.01），平均 Rose 呼吸困难评分从 2.0±0.1 降低到 1.1±0.1（p<0.01），以及医师健康问卷（抑郁）评分从 6.2±0.2 降低到 3.5±0.1（p<0.01）。调整基线差异后，成功与不成功 CTO PCI 之间西雅图心绞痛问卷生活质量的平均组间差异为 10.8（95%置信区间：6.3 至 15.3；p<0.001）。
阐明 CTO PCI 的成功率、风险和获益将有助于更准确地为这些手术提供知情同意过程的背景信息，以便具有适当 CTO PCI 适应证的患者能够更有效地参与决策，选择进行 CTO PCI 或其他治疗选择。
