Nakachi Tatsuya, Kohsaka Shun, Yamane Masahisa, Muramatsu Toshiya, Okamura Atsunori, Kashima Yoshifumi, Matsuno Shunsuke, Sakurada Masami, Seino Yoshitane, Habara Maoto
Department of Cardiology, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matsudasoryo, Matsuda-machi, Ashigarakami-gun, Kanagawa 258-0003, Japan.
Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
J Clin Med. 2020 May 2;9(5):1319. doi: 10.3390/jcm9051319.
Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading "survival advantage" conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs).
Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality.
Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes ( interaction = 0.043), multivessel disease ( interaction = 0.175), Canadian Cardiovascular Society class ≥2 ( interaction = 0.088), and prior myocardial infarction (MI) ( interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were -0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI ( interaction = 0.19), left anterior descending artery (LAD)-CTO ( interaction = 0.079), and reattempt of CTO-PCI ( interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were -1.7%, 7.5%, and 15.1%, respectively.
The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.
经皮冠状动脉介入治疗（PCI）在慢性完全闭塞（CTO）患者中广泛应用，但其在改善长期预后方面的益处存在争议。我们旨在制定一个预测评分，用于对CTO-PCI成功结果所带来的“生存优势”进行分级，并建立一个评分系统，以预测CTO-PCI结果对主要不良心脑血管事件（MACCE）的影响。
分析了日本65个中心2625例接受CTO-PCI患者的随访数据。通过纳入CTO-PCI成功与一年死亡率之间关联的统计效应修正因素，开发了一个整数评分系统。
2034例患者完成了12个月的随访。随访期间，发生76例死亡（3.7%）。CTO-PCI成功的患者一年生存率高于CTO-PCI失败的患者（对数秩检验P=0.016）。成功手术与一年死亡率之间关联的效应修正因素包括糖尿病（交互作用P=0.043）、多支血管病变（交互作用P=0.175）、加拿大心血管学会分级≥2级（交互作用P=0.088）和既往心肌梗死（MI）（交互作用P=0.117）。每个因素赋予1分并相加，以建立评分系统。然后将患者分类，以明确PCI成功对生存优势的预测：≤2分（正常）和≥3分（显著）。正常和显著评分类别中，成功与失败治疗患者的一年死亡率差异分别为-0.7%和11.3%。在MACCE评分系统中，评分因素包括既往MI（交互作用P=0.19）、左前降支（LAD）-CTO（交互作用P=0.079）和CTO-PCI再次尝试（交互作用P=0.18）。每个评分类别（0分、1分和≥2分）中，成功与失败患者的一年MACCE差异分别为-1.7%、7.5%和15.1%。
评估PCI成功优势的新型评分系统可轻松应用于CTO患者。它是临床决策的有效工具，可用于评估CTO-PCI的生存优势以及手术结果对MACCE的影响。
