Guo Lei, Zhang Shanfeng, Wu Jian, Zhong Lei, Ding Huaiyu, Xu Jiaying, Zhou Xuchen, Huang Rongchong
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.
Scand Cardiovasc J. 2019 Dec;53(6):305-311. doi: 10.1080/14017431.2019.1645351. Epub 2019 Jul 24.
To compare the clinical outcomes associated with successful percutaneous coronary intervention (PCI) versus initial medical therapy (MT) in patients with coronary chronic total occlusions (CTOs). Between January 2007 and December 2016, a total of 1702 patients with ≥1 CTO were enrolled. Patients who had a failed CTO-PCI were excluded. After exclusion, 1294 patients with 1520 CTOs were divided into the MT group initially (did not undergo a CTO-PCI attempt) ( = 800) and successful PCI group ( = 494). Propensity-score matching was also performed to adjust for baseline characteristics. The primary outcome was cardiac death. The median overall follow-up duration was 3.6 (IQR, 2.1-5.0) years, there was no significant difference between the two groups with respect to the prevalence of cardiac death (MT vs. successful PCI: 6.6 vs. 3.8%, adjusted hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.41-2.14, = .867). In the propensity-matched population (286 pairs), there were no significant differences in the prevalence of cardiac death (MT vs. successful PCI: 5.9% vs. 3.1%, HR 0.51, 95% CI 0.23-1.15, = .104) and major adverse cardiovascular events (MACE) (HR 0.76, 95% CI 0.53-1.09, = .130) between the two groups. In the treatment of patients with CTOs, successful PCI is not associated with improved long-term cardiovascular survival or reduced the risk of MACE compared with MT alone initially.
比较冠状动脉慢性完全闭塞（CTO）患者成功进行经皮冠状动脉介入治疗（PCI）与初始药物治疗（MT）的临床结局。2007年1月至2016年12月，共纳入1702例患有≥1处CTO的患者。排除CTO-PCI失败的患者。排除后，1294例患有1520处CTO的患者最初被分为MT组（未尝试进行CTO-PCI）（n = 800）和成功PCI组（n = 494）。还进行了倾向评分匹配以调整基线特征。主要结局是心源性死亡。中位总随访时间为3.6（IQR，2.1 - 5.0）年，两组在心源性死亡患病率方面无显著差异（MT组与成功PCI组：6.6% 对3.8%，调整后风险比[HR] 0.93，95%置信区间[CI] 0.41 - 2.14，P = 0.867）。在倾向匹配人群（286对）中，两组在心源性死亡患病率（MT组与成功PCI组：5.9% 对3.1%，HR 0.51，95% CI 0.23 - 1.15，P = 0.104）和主要不良心血管事件（MACE）（HR 0.76，95% CI 0.53 - 1.09，P = 0.130）方面无显著差异。在CTO患者的治疗中，与单纯初始MT相比，成功PCI与改善长期心血管生存或降低MACE风险无关。
