Park Ji Young, Choi Byoung Geol, Rha Seung-Woon, Kang Tae Soo, Choi Cheol Ung, Yu Cheol Woong, Gwon Hyeon-Cheol, Chae In-Ho, Kim Hyo-Soo, Park Hun Sik, Lee Seung-Hwan, Kim Moo-Hyun, Hur Seung-Ho, Jang Yangsoo
Department of Internal Medicine, Division of Cardiology, Eulji Hospital, Eulji University.
Department of Internal Medicine, Division of Cardiology, Korea University Graduate School.
Coron Artery Dis. 2018 Sep;29(6):495-501. doi: 10.1097/MCA.0000000000000630.
The Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes.
Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model.
After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality.
In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.
韩国慢性完全闭塞（CTO）注册研究自2007年5月起前瞻性收集了来自26个心血管中心的数据。本研究的目的是调查急性心肌梗死（AMI）患者中成功的分期经皮冠状动脉介入治疗（PCI）对CTO病变的临床结局的影响。
在因CTO病变接受分期PCI的2813例患者中，422例（15%）因AMI接受了直接PCI。在这422例患者中，76%成功进行了分期CTO-PCI。比较了成功CTO-PCI组（n=321）和失败CTO-PCI组（n=101）的临床结局。为调整潜在混杂因素，使用逻辑回归模型进行倾向评分匹配（PSM）分析。
PSM分析后，生成了两个倾向匹配组（85对，n=170），基线特征得到平衡。失败CTO-PCI组1年时的全因死亡（P=0.029）和非ST段抬高型心肌梗死（NSTEMI，P=0.043）发生率更高。多因素回归显示，成功的CTO-PCI是预防死亡的独立预测因素（风险比，0.21，P=0.048）。在亚组分析中，Kaplan-Meier曲线显示，在NSTEMI患者中，成功的CTO-PCI在1年内全因死亡（对数秩=0.004）和心源性死亡（对数秩=0.005）的发生率较低。Cox比例分析显示，成功的CTO-PCI对NSTEMI、高血压和非左前降支病变患者预防死亡有益。
在本研究中，AMI患者分期成功的CTO-PCI与韩国人群1年生存率的提高相关。
