Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany.
Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany.
Thromb Haemost. 2017 Nov;117(11):2105-2115. doi: 10.1160/TH17-06-0381. Epub 2017 Nov 30.
As technologies of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) have improved, great uncertainty exists regarding patient selection and long-term benefit of CTO-PCI. Given that white blood cell (WBC) count has been associated with cardiovascular risk, we hypothesized that the latter might provide incremental prognostic value in patients undergoing CTO-PCI. Our study population consisted of 1,262 consecutive patients (76.3% males, mean age of 67.7 ± 10.3 years) who underwent elective PCI at our centre between January 2002 and December 2008. Four hundred seventy-five patients had at least one CTO, while 787 patients with non-occlusive coronary lesions served as controls. Baseline WBC count was higher in CTO patients as compared with controls (8,072 ± 3,459/μL vs. 7,469 ± 2,668/μL, = 0.001) and independently predicted the occurrence of a CTO lesion (odds ratio: 1.8; 95% confidence interval [CI]: 1.3-2.4; < 0.001). After a median follow-up of 3.1 years (interquartile range: 2.1-4.2 years), CTO patients with WBC counts ranging in the highest tertile had significantly worse outcomes than CTO patients with lower WBC counts (log-rank = 0.009 for all-cause mortality and log-rank = 0.01 for major adverse cardiac events). These associations were not seen in controls. Accordingly, elevated WBC count was identified as a significant predictor for all-cause mortality (adjusted hazard ratio: 3.1; 95% CI: 1.6-6.2; = 0.001) in CTO patients but not in patients with non-occlusive coronary artery disease ( = 0.088). Assessment of the inflammatory status of CTO patients may be an important element in selecting CTO patients at low risk who may be referred to CTO-PCI.
随着经皮冠状动脉介入治疗（PCI）治疗冠状动脉慢性完全闭塞（CTO）技术的提高，对于 CTO-PCI 的患者选择和长期获益仍存在较大的不确定性。鉴于白细胞计数（WBC）与心血管风险相关，我们假设其可能为接受 CTO-PCI 的患者提供额外的预后价值。
我们的研究人群包括 2002 年 1 月至 2008 年 12 月期间在我院接受择期 PCI 的 1262 例连续患者（76.3%为男性，平均年龄为 67.7±10.3 岁）。475 例患者至少有 1 处 CTO，而 787 例非闭塞性冠状动脉病变患者作为对照。与对照组相比，CTO 患者的基线 WBC 计数更高（8072±3459/μL 比 7469±2668/μL， = 0.001），并独立预测 CTO 病变的发生（比值比：1.8；95%置信区间[CI]：1.3-2.4； < 0.001）。中位随访 3.1 年（四分位距：2.1-4.2 年）后，WBC 计数处于最高三分位数的 CTO 患者的结局明显比 WBC 计数较低的 CTO 患者差（所有原因死亡率的对数秩检验 = 0.009，主要不良心脏事件的对数秩检验 = 0.01）。在对照组中未观察到这些关联。因此，在 CTO 患者中，高 WBC 计数被确定为全因死亡率的显著预测因素（校正后的危险比：3.1；95%CI：1.6-6.2； = 0.001），但在非闭塞性冠状动脉疾病患者中则不然（ = 0.088）。评估 CTO 患者的炎症状态可能是选择低危 CTO 患者并将其转介至 CTO-PCI 的重要因素。
