Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijengbu, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
J Cardiol. 2019 Feb;73(2):156-162. doi: 10.1016/j.jjcc.2018.08.006. Epub 2018 Nov 6.
Chronic total occlusion (CTO) is a challenging entity in coronary interventions. With improvements in technology and techniques, success rates for percutaneous coronary intervention (PCI) of CTO continue to improve. However, the clinical benefits of PCI remain unclear. The aim of the study was to determine the effectiveness of successful PCI on clinical outcomes using drug-eluting stents in patients with CTO.
From 2004 to 2010, we analyzed 898 patients with at least one CTO who underwent successful PCI (n=424, 448 lesions) or only medical treatment (n=474, 519 lesions) from a multicenter registry. The primary outcome was all-cause death.
During a median of 2.2 years, incidence rate of all-cause death after successful PCI was lower than that after medical treatment (10.6% and 17.5%, p=0.004). However, the multivariate Cox proportional hazards model showed that successful PCI was not associated with improvement in mortality compared to medical treatment [adjusted hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.57-1.24, p=0.38]. Comparable results were obtained after propensity-score matching. Subgroup analysis of propensity-score matched population demonstrated that patients with age under 65 years benefited from successful PCI (HR 0.25, 95% CI 0.08-0.75, p for interaction=0.005).
In patients considered for CTO intervention, medical treatment appears to be associated with a similar mortality compared to successful PCI. Successful CTO PCI might be associated with survival benefit in younger patients compared to medical treatment.
慢性完全闭塞（CTO）是冠状动脉介入治疗中的一个具有挑战性的实体。随着技术和技术的进步，CTO 的经皮冠状动脉介入治疗（PCI）成功率继续提高。然而，PCI 的临床获益仍不清楚。本研究旨在使用药物洗脱支架确定成功 PCI 对 CTO 患者临床结局的有效性。
我们分析了 2004 年至 2010 年期间，898 例至少有一条 CTO 并接受成功 PCI（n=424，448 个病变）或仅接受药物治疗（n=474，519 个病变）的患者，这些患者来自一个多中心登记处。主要结局是全因死亡。
在中位数为 2.2 年的随访期间，成功 PCI 后全因死亡率低于药物治疗（10.6%和 17.5%，p=0.004）。然而，多变量 Cox 比例风险模型显示，与药物治疗相比，成功 PCI 与死亡率的改善无关[校正风险比（HR）0.84，95%置信区间（CI）0.57-1.24，p=0.38]。倾向评分匹配后也得到了类似的结果。倾向评分匹配人群的亚组分析表明，年龄小于 65 岁的患者从成功 PCI 中获益（HR 0.25，95%CI 0.08-0.75，p 交互=0.005）。
在考虑进行 CTO 干预的患者中，药物治疗与成功 PCI 相比，死亡率似乎相似。与药物治疗相比，成功的 CTO PCI 可能与年轻患者的生存获益相关。
