冠状动脉慢性完全闭塞对心律失常和死亡结局的影响：系统评价和荟萃分析。
Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis.
机构信息
Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
出版信息
JACC Clin Electrophysiol. 2018 Sep;4(9):1214-1223. doi: 10.1016/j.jacep.2018.06.011. Epub 2018 Jul 25.
OBJECTIVES
This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy.
BACKGROUND
CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy.
METHODS
PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies.
RESULTS
Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I = 64%). Compared to patients with non-infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I = 76).
CONCLUSIONS
CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
目的
本研究旨在探讨慢性冠状动脉完全闭塞（CTO）与室性心动过速（VT）/心室颤动（VF）或适当的植入式心脏复律除颤器（ICD）治疗发生之间的关系。
背景
CTO 是缺血性心脏病患者的一个重大问题。然而，它使受影响个体发生 VT/VF 的倾向性程度，以及这些心律失常事件是否可以通过血运重建来预防，尚不清楚。因此，进行了一项系统评价和荟萃分析，以评估 CTO 状态与 VT/VF 或适当的 ICD 治疗发生之间的关系。
方法
检索 PubMed 和 Embase 数据库，截至 2017 年 11 月 16 日，共识别出 137 项研究，涉及 54594 例患者（平均年龄 61±21 岁，81%为男性），平均随访 43±31 个月。
结果
纳入了 17 项研究，共涉及 54594 例患者（平均年龄 61±21 岁，81%为男性），平均随访 43±31 个月。存在 CTO 与 VT/VF 或适当的 ICD 治疗发生的风险增加相关（调整后的危险比[aHR]：1.99；95%置信区间[CI]：1.53 至 2.59；p<0.0001，I²=3%），但与心脏死亡率（aHR：2.59；95%CI：0.64 至 10.59；p=0.18，I²=86%）或全因死亡率（aHR：1.70；95%CI：0.84 至 3.46；p=0.14，I²=64%）无关。与非梗死相关 CTO 患者相比，梗死相关 CTO 患者 VT/VF 或适当的 ICD 治疗发生的风险更高（aHR：2.47；95%CI：1.76 至 3.46；p<0.0001；I²=14%）、心脏死亡率（aHR：2.73；95%CI：1.02 至 7.30；p<0.05；I²=79%）和更高的全因死亡率（aHR：1.69；95%CI：1.19 至 2.40；p<0.01；I²=40%）。与成功血运重建相比，CTO 非血运重建患者的全因死亡率增加（未调整的 HR：1.52；95%CI：0.96 至 2.43；p=0.08；I²=76%）。
结论
CTO，特别是梗死相关的 CTO，与 VT/VF 或适当的 ICD 治疗和死亡率的高风险相关。植入 ICD 可能有益。然而，尚不清楚血运重建是否对 CTO 患者的结局有影响。
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