Sliman Hussein, Flugelman Moshe Y, Lavi Idit, Zafrir Barak, Shiran Avinoam, Eitan Amnon, Jaffe Ronen
Department of Cardiology, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Community Medicine and Epidemiology, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Isr Med Assoc J. 2020 Mar;22(3):169-172.
The impact of revascularization of coronary chronic total occlusion (CTO) on survival is unknown. Several studies, which included subjects with varied coronary anatomy, suggested that CTO revascularization improved survival. However, the contribution of CTO revascularization to improved outcome is unclear since it was more commonly achieved in subjects with fewer co-morbidities and less extensive coronary disease.
To study the association between CTO revascularization and survival in patients with uniform coronary anatomy consisting of isolated CTO of the right coronary artery (RCA).
A registry of 16,832 coronary angiograms was analyzed. We identified 278 patients (1.7%) with isolated CTO of the RCA who did not have lesions within the left coronary artery for which revascularization was indicated. Survival of 52 patients (19%) who underwent successful percutaneous coronary intervention was compared to those who did not receive revascularization.
Revascularized patients were younger (60.2 vs. 66.3 years, P = 0.001), had higher creatinine clearance (106 vs. 83 ml/min, P < 0.0001), and had fewer co-morbidities than those who did not receive revascularization. Lack of CTO revascularization was a univariable predictor of mortality (hazard ratio [HR] = 2.65, 95% confidence interval [95%CI] 1.06-6.4) over 4.3 ± 2.5 years of follow-up. On multivariable analysis, the only predictors of mortality were increased age (HR 1.04, 95%CI 1.01-1.07), reduced creatinine clearance (HR 1.02, 95%CI 1.01-1.03), and ejection fraction below 55% (HR 2.24, 95%CI 1.22-4.11).
Among patients with isolated RCA CTO who underwent extended follow-up, revascularization was not an independent predictor of increased survival.
冠状动脉慢性完全闭塞（CTO）血运重建对生存率的影响尚不清楚。几项研究纳入了冠状动脉解剖结构各异的受试者，提示CTO血运重建可提高生存率。然而，CTO血运重建对改善预后的作用尚不清楚，因为它在合并症较少和冠状动脉疾病范围较小的受试者中更常实现。
研究在右冠状动脉（RCA）孤立性CTO构成的统一冠状动脉解剖结构患者中，CTO血运重建与生存率之间的关联。
分析了16832例冠状动脉造影登记数据。我们确定了278例（1.7%）RCA孤立性CTO且左冠状动脉内无需要血运重建病变的患者。将52例（19%）成功接受经皮冠状动脉介入治疗的患者的生存率与未接受血运重建的患者进行比较。
与未接受血运重建的患者相比，接受血运重建的患者更年轻（60.2岁对66.3岁，P = 0.001），肌酐清除率更高（106对83 ml/min，P < 0.0001），合并症更少。在4.3±2.5年的随访中，未进行CTO血运重建是死亡率的单变量预测因素（风险比[HR]=2.65，95%置信区间[95%CI]1.06 - 6.4）。多变量分析显示，死亡率的唯一预测因素是年龄增加（HR 1.04，95%CI 1.01 - 1.07）、肌酐清除率降低（HR 1.02，95%CI 1.01 - 1.03）和射血分数低于55%（HR 2.24，95%CI 1.22 - 4.11）。
在接受长期随访的RCA孤立性CTO患者中，血运重建不是生存率提高的独立预测因素。
