Megaly Michael, Saad Marwan, Tajti Peter, Burke M Nicholas, Chavez Ivan, Gössl Mario, Lips Daniel, Mooney Michael, Poulose Anil, Sorajja Paul, Traverse Jay, Wang Yale, Kohl Louis P, Bradley Steven M, Brilakis Emmanouil S
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
J Interv Cardiol. 2018 Oct;31(5):562-571. doi: 10.1111/joic.12538. Epub 2018 Jul 4.
We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function.
We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function.
A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7.9 months, successful CTO PCI was associated with an increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001, I = 45%). In secondary analysis of 15 studies (1248 patients) that defined CTOs as occlusions of at least 3-month duration and reported follow-up of at least 3-months after the procedure, successful CTO PCI was associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV end-systolic volume, successful CTO PCI was associated with a decrease in LV end-systolic volume by 4 mL, (95%CI -6.0 to -2.1, P < 0.0001, I = 0%). LV end-diastolic volume was reported in 9 studies with 403 patients and did not significantly change after successful CTO PCI (-2.3 mL, 95%CI -5.7 to 1.2 mL, P = 0.19, I = 0%).
Successful CTO PCI is associated with a statistically significant improvement in LV ejection fraction and decrease in LV end-systolic volume, that may reflect a beneficial effect of CTO recanalization on LV remodeling. The clinical implications of these findings warrant further investigation.
我们试图研究冠状动脉慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）对左心室（LV）功能的影响。
我们对1980年1月至2017年11月发表的关于成功的CTO PCI对LV功能影响的研究进行了系统评价和荟萃分析。
荟萃分析共纳入34项观察性研究，包括2735例患者。在加权平均随访7.9个月时，成功的CTO PCI与LV射血分数增加3.8%相关（95%CI 3.0 - 4.7，P < 0.0001，I² = 45%）。在15项研究（1248例患者）的二次分析中，这些研究将CTO定义为至少持续3个月的闭塞，并报告了术后至少3个月的随访情况，成功的CTO PCI与LV射血分数提高4.3%相关（95%CI [3.1, 5.6]，P < 0.0001）。在10项报告LV收缩末期容积的研究（502例患者）中，成功的CTO PCI与LV收缩末期容积减少4 mL相关（95%CI -6.0至-2.1，P < 0.0001，I² = 0%）。9项研究（403例患者）报告了LV舒张末期容积，成功的CTO PCI后其无显著变化（-2.3 mL，95%CI -5.7至1.2 mL，P = 0.19，I² = 0%）。
成功的CTO PCI与LV射血分数在统计学上的显著改善以及LV收缩末期容积的减少相关，这可能反映了CTO再通对LV重构的有益作用。这些发现的临床意义值得进一步研究。
