Rha Seung Woon, Choi Byoung Geol, Baek Man Jong, Ryu Yang Gi, Li Hu, Choi Se Yeon, Byun Jae Kyeong, Mashaly Ahmed, Park Yoonjee, Jang Won Young, Kim Woohyeun, Choi Jah Yeon, Park Eun Jin, Na Jin Oh, Choi Cheol Ung, Lim Hong Euy, Kim Eung Ju, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo
Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Research Institute of Health Sciences, Korea University College of Health Science, Seoul, Korea.
Yonsei Med J. 2018 Jul;59(5):602-610. doi: 10.3349/ymj.2018.59.5.602.
Many recent studies have reported that successful percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for chronic total occlusion (CTO) has more beneficial effects than failed CTO-PCI; however, there are only limited data available from comparisons of successful CTO-PCI with medical therapy (MT) in the Korean population.
A total of 840 consecutive CTO patients who underwent diagnostic coronary angiography, receiving either PCI with DESs or MT, were enrolled. Patients were divided into two groups according to the treatment assigned. To adjust for potential confounders, propensity score matching (PSM) analysis was performed using logistic regression. Individual major clinical outcomes and major adverse cardiac events, a composite of total death, myocardial infarction (MI), stroke, and revascularization, were compared between the two groups up to 5 years.
After PSM, two propensity-matched groups (265 pairs, n=530) were generated, and the baseline characteristics were balanced. Although the PCI group showed a higher incidence of target lesion and vessel revascularization on CTO, the incidence of MI tended to be lower [hazard ratio (HR): 0.339, 95% confidence interval (CI): 0.110 to 1.043, p=0.059] and the composite of total death or MI was lower (HR: 0.454, 95% CI: 0.224 to 0.919, p=0.028), compared with the MT group up to 5 years.
In this study, successful CTO PCI with DESs was associated with a higher risk of repeat PCI for the target vessel, but showed a reduced incidence of death or MI.
近期许多研究报告称，药物洗脱支架（DES）成功用于经皮冠状动脉介入治疗（PCI）慢性完全闭塞病变（CTO）比CTO-PCI失败具有更多有益效果；然而，在韩国人群中，成功的CTO-PCI与药物治疗（MT）比较的数据有限。
共纳入840例连续接受诊断性冠状动脉造影的CTO患者，这些患者接受DES-PCI或MT治疗。根据分配的治疗方法将患者分为两组。为调整潜在混杂因素，采用逻辑回归进行倾向评分匹配（PSM）分析。比较两组长达5年的个体主要临床结局和主要不良心脏事件，后者是全因死亡、心肌梗死（MI）、卒中及血运重建的综合指标。
PSM后，产生了两个倾向匹配组（265对，n = 530），基线特征均衡。虽然PCI组CTO的靶病变和血管血运重建发生率较高，但MI发生率倾向于较低[风险比（HR）：0.339，95%置信区间（CI）：0.110至1.043，p = 0.059]，且全因死亡或MI的综合发生率较低（HR：0.454，95%CI：0.224至0.919，p = 0.028），与MT组长达5年的情况相比。
在本研究中，DES成功用于CTO PCI与靶血管再次PCI的较高风险相关，但显示死亡或MI发生率降低。
