Goel Pravin K, Khanna Roopali, Pandey C M, Ashfaq Fauzia
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Biostatistics and Health Informatic, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
J Interv Cardiol. 2018 Jun;31(3):293-301. doi: 10.1111/joic.12480. Epub 2018 Jan 4.
Long term clinical outcomes post chronic total occlusion (CTO) intervention may depend not only on CTO success/failure alone but also on Completeness of revascularization.
To determine long term outcomes post CTO intervention and relate them to both success versus failure and Complete Revascularization (CR) versus Incomplete Revascularization (IR).
Consecutive patients taken up for CTO intervention with at-least one CTO vessel between Jan 2006 to Dec 2015 were included. Clinical, procedural and follow up details were recorded in a pre-specified custom made software. Primary endpoint of the study was survival free of major adverse event individual, death, myocardial infarction (MI), repeat revascularisation (percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) and recurrent or continued angina. Each individual adverse event was considered as a secondary end point.
A total of 632 patients were enrolled in study with follow up data available in 549 (86%) constituting the study group with 490 (89.3%) success and 59 (11.7%) failure. Complete revascularization (CR) was obtained in 410 (74.7%). Follow up was median 2.9 years with inter-quartile range 1.1-4.8 years. Kaplan Meier survival analysis showed a better EFS with both CTO success versus failure (P = 0.03)and CR versus IR (P = 0.017). Individual adverse outcomes however were not significantly different in CTO success versus failure group but significantly better when analyzed with respect to CR versus IR including death (P = 0.049) and recurrent angina (P = 0.024). Repeat intervention and MI were not different by either analysis.
Successful CTO PCI results in a better long term event free survival but the difference between the groups is more if analyzed with respect to completeness of revascularization rather than CTO success/failure alone.
慢性完全闭塞（CTO）介入治疗后的长期临床结果可能不仅取决于CTO治疗的成功与否，还取决于血管重建的完整性。
确定CTO介入治疗后的长期结果，并将其与成功与失败以及完全血管重建（CR）与不完全血管重建（IR）相关联。
纳入2006年1月至2015年12月期间接受CTO介入治疗且至少有一支CTO血管的连续患者。临床、手术和随访细节记录在预先指定的定制软件中。该研究的主要终点是无主要不良事件个体的生存、死亡、心肌梗死（MI）、再次血管重建（经皮冠状动脉介入治疗[PCI]或冠状动脉旁路移植术[CABG]）以及复发性或持续性心绞痛。每个个体不良事件被视为次要终点。
共有632例患者纳入研究，其中549例（86%）有随访数据，构成研究组，490例（89.3%）成功，59例（11.7%）失败。410例（74.7%）实现了完全血管重建（CR）。随访时间中位数为2.9年，四分位间距为1.1 - 4.8年。Kaplan Meier生存分析显示，CTO成功组与失败组相比（P = 0.03）以及CR组与IR组相比（P = 0.017），无事件生存期更好。然而，CTO成功组与失败组的个体不良结局无显著差异，但在分析CR组与IR组时，包括死亡（P = 0.049）和复发性心绞痛（P = 0.024），情况明显更好。再次干预和MI在两种分析中均无差异。
成功的CTO PCI可带来更好的长期无事件生存，但如果根据血管重建的完整性而非仅CTO的成功与否进行分析，两组之间的差异会更大。
