老年患者冠状动脉慢性完全闭塞病变药物治疗与成功再通的长期预后比较：1294例患者的报告
Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients.
作者信息
Guo Lei, Lv Haichen, Zhong Lei, Wu Jian, Ding Huaiyu, Xu Jiaying, Huang Rongchong
机构信息
Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China.
出版信息
Cardiovasc Diagn Ther. 2019 Dec;9(6):586-595. doi: 10.21037/cdt.2019.11.01.
BACKGROUND
Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs).
METHODS
There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age <65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups: 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE).
RESULTS
After 3.6 (IQR, 2.1-5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups in terms of cardiac mortality (MT successful CTO-PCI: 9.3% 5.0%, P=0.378) and MACE (28.3% 15.1%, P=0.070) in the older group. After propensity score matching analysis (120 pairs), the risk of cardiac mortality (6.7% 8.3%, P=0.624) was found to be comparable between the two groups. In the younger group, the occurrence of cardiac death (MT successful CTO-PCI: 3.7% 1.4%, P=0.072) was similar, whereas the MACE rate (27.7% 17.9%, P=0.003) was significantly higher in MT group. After multivariate analysis, previous myocardial infarction (MI) [hazard ratio (HR) 1.70, 95% confidence interval (CI): 1.16-2.49, P=0.006], CTO in right coronary artery (HR 1.55, 95% CI: 1.07-2.25, P=0.020), multivessel disease (HR 2.02, 95% CI: 1.10-3.72, P=0.024) and calcification (HR 1.61, 95% CI: 1.07-2.42, P=0.023) were independent predictors of MACE in elderly.
CONCLUSIONS
In the treatment of elderly patients with CTOs, successful CTO-PCI compared with MT alone didn't reduce the risk of cardiac death or MACE.
背景
对于老年冠状动脉慢性完全闭塞（CTO）患者，药物治疗（MT）与成功的经皮冠状动脉介入治疗（PCI）的长期结局了解甚少。
方法
纳入2007年至2016年连续的1294例患者的1520处CTO，分为较年轻组（年龄<65岁；n = 664，51.3%）和较年长组（年龄≥65岁；n = 630，48.7%）。在较年长组中，根据初始治疗策略将630例患者分为MT组（n = 421）和成功的CTO-PCI组（n = 209）。在较年轻组中，分为两组：MT组379例患者和成功的CTO-PCI组285例患者。我们进行倾向评分匹配以尽量减少任何选择偏倚。主要终点是心源性死亡。次要终点是主要不良心脏事件（MACE）。
结果
经过3.6（IQR，2.1 - 5.0）年的随访，在较年长组中，MT组和成功的CTO-PCI组在心源性死亡（MT组 成功的CTO-PCI组：9.3% 5.0%，P = 0.378）和MACE（28.3% 15.1%，P = 0.070）方面未观察到显著差异。经过倾向评分匹配分析（120对），发现两组之间的心源性死亡风险（6.7% 8.3%，P = 0.624）相当。在较年轻组中，心源性死亡的发生率（MT组 成功的CTO-PCI组：3.7% 1.4%，P = 0.072）相似，而MT组的MACE发生率（27.7% 17.9%，P = 0.003）显著更高。经过多变量分析，既往心肌梗死（MI）[风险比（HR）1.70，95%置信区间（CI）：1.16 - 2.49，P = 0.006]、右冠状动脉CTO（HR 1.55，95%CI：1.07 - 2.25，P = 0.020）、多支血管病变（HR 2.02，95%CI：1.10 - 3.72，P = 0.024）和钙化（HR 1.61，95%CI：1.07 - 2.42，P = 0.023）是老年患者MACE的独立预测因素。
结论
在老年CTO患者的治疗中，与单独MT相比，成功的CTO-PCI并未降低心源性死亡或MACE的风险。
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