Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
EuroIntervention. 2020 Aug 7;16(6):e462-e471. doi: 10.4244/EIJ-D-19-00631.
The aim of this study was to explore the relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI).
A total of 193 consecutive patients underwent [15O]H2O positron emission tomography prior to and three months after successful CTO PCI. Change in perfusion defect size, quantitative hyperaemic myocardial blood flow (MBF) and coronary flow reserve (CFR) within the CTO area were compared among patients with limited (0-1 segment, N=15), moderate (2-3 segments, N=61) and large (≥4 segments, N=117) perfusion defects. Median reductions in defect size were 1 [0-1], 2 [1-3], and 4 [2-5] segments in patients with a limited, moderate and large defect (all comparisons p<0.01). Hyperaemic MBF and CFR improved significantly regardless of baseline defect size (overall between groups p=0.45 and p=0.55). After stratification of patients to a low, intermediate or high tertile according to baseline hyperaemic MBF or CFR levels, changes in hyperaemic MBF and CFR after CTO PCI were comparable between tertiles (overall p=0.75 and p=0.79).
Major reductions in ischaemic burden can be achieved following CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperaemic MBF and CFR improve significantly irrespective of their baseline values or perfusion defect size.
本研究旨在探讨慢性完全闭塞(CTO)经皮冠状动脉介入治疗(PCI)后缺血负担与绝对心肌灌注变化之间的关系。
共有 193 例连续患者在成功 CTO PCI 前和 3 个月后接受[15O]H2O 正电子发射断层扫描。在 CTO 区域内,比较灌注缺损大小、定量充血心肌血流(MBF)和冠状血流储备(CFR)变化,分为局限性(0-1 节段,N=15)、中度(2-3 节段,N=61)和广泛性(≥4 节段,N=117)。局限性、中度和广泛性缺陷患者的缺陷大小中位数分别减少 1[0-1]、2[1-3]和 4[2-5]个节段(所有比较 p<0.01)。无论基线缺陷大小如何,充血性 MBF 和 CFR 均显著改善(总体组间 p=0.45 和 p=0.55)。根据基线充血性 MBF 或 CFR 水平将患者分层为低、中或高三分位数后,CTO PCI 后充血性 MBF 和 CFR 的变化在三分位数之间相当(总体 p=0.75 和 p=0.79)。
CTO PCI 后可显著降低缺血负担,大灌注缺陷患者的缺陷大小减少更多,而充血性 MBF 和 CFR 显著改善,与基线值或灌注缺陷大小无关。