Yoshida Ruka, Ishii Hideki, Morishima Itsuro, Tanaka Akihito, Takagi Kensuke, Yoshioka Naoki, Kataoka Takashi, Tashiro Hiroshi, Hitora Yusuke, Niwa Kiyoshi, Furusawa Kenji, Morita Yasuhiro, Tsuboi Hideyuki, Murohara Toyoaki
Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan.
Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Cardiovasc Interv Ther. 2020 Jul;35(3):259-268. doi: 10.1007/s12928-019-00615-8. Epub 2019 Aug 27.
Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17-0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.
尽管非梗死相关动脉（非IRA）中的慢性完全闭塞（CTO）对接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者的长期死亡率有负面影响，但成功进行CTO-PCI的预后影响尚未得到充分研究。在1855例连续接受直接PCI的AMI患者中，纳入了那些接受PCI或药物治疗CTO的患者。我们评估了CTO再通与长期心脏死亡率之间的关联。在纳入的172例患者中，88例接受了CTO-PCI，其中65例手术成功。因此，成功再通CTO（SR-CTO）组包括65例患者；未再通CTO（NR-CTO）组包括107例患者。随访期间，72例患者死亡，其中56例（77.8%）死于心脏原因。SR-CTO组的累积10年、30天以及30天至10年心脏死亡率低于NR-CTO组（分别为19.0%对51.9%，p = 0.004；4.6%对14.0%，p = 0.05；15.0%对44.1%，p = 0.003）。在调整混杂因素后，与NR-CTO相比，SR-CTO对10年心脏死亡率的益处仍然显著（风险比0.37；95%置信区间0.17 - 0.75；p = 0.004）。总之，与NR-CTO患者相比，AMI后非IRA中存在SR-CTO的患者长期心脏死亡率降低。
