Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom.
J Invasive Cardiol. 2020 Sep;32(9):350-357. doi: 10.25270/jic/20.00180. Epub 2020 Aug 10.
There are limited data comparing outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with stable angina who undergo percutaneous coronary intervention (PCI) to either a saphenous vein grafts (SVG) or a chronic total occlusion (CTO) in the native coronary arteries. We compared clinical characteristics and outcomes of these two groups in a national cohort.
We formed a longitudinal cohort (2007-2014; n = 11,132) of patients who underwent SVG-PCI (group 1; n = 8619) or CTO-PCI in native arteries (group 2; n = 2513) in the British Cardiovascular Intervention Society (BCIS) database. Median age was 68 years in both groups, but patients in group 2 were less likely to be female, had a higher prevalence of diabetes mellitus, hypertension, hypercholesterolemia, and previous myocardial infarction, as well as worsened angina and breathlessness, but history of prior stroke, renal diseases, and the presence of left ventricular systolic dysfunction were similar to group 1. Following multivariable analysis, no significant difference in mortality was observed during index hospital admission (odds ratio [OR], 1.70; 95% confidence interval [CI], 0.63-4.58; P=.29), at 30 days (OR, 1.81; 95% CI, 0.99-3.3; P=.05), and 1 year (OR, 1.11; 95% CI, 0.85-1.44; P=.43), nor was a significant difference found in in-hospital MACE rates (OR, 1.36; 95% CI, 0.85-2.19; P=.19). However, CTO-PCI was associated with more procedural complications (OR, 2.88; 95% CI, 2.38-3.47; P<.01) and vessel perforation (OR, 4.82; 95% CI, 2.80-8.28; P<.01) as compared with the SVG-PCI group. Risk of target-vessel revascularization at 1 year was similar (SVG-PCI 5.6% vs CTO-PCI 6.9%; P=.08).
In this national cohort, CTO-PCI was performed in higher-risk patients, and was associated with more procedural complications but similar short-term or long-term mortality and in-hospital MACE.
目前仅有有限的数据比较了既往行冠状动脉旁路移植术（CABG）后稳定型心绞痛患者行经皮冠状动脉介入治疗（PCI）时，处理桥血管（SVG）或慢性完全闭塞（CTO）病变的临床结局。本研究在全国队列中比较了这两组患者的临床特征和结局。
我们构建了一个纵向队列（2007-2014 年），该队列中患者在英国心血管介入学会（BCIS）数据库中行 SVG-PCI（第 1 组，n=8619）或 CTO-PCI 于原位血管（第 2 组，n=2513）。两组患者的中位年龄均为 68 岁，但第 2 组患者女性比例较低，糖尿病、高血压、高胆固醇血症和既往心肌梗死的患病率更高，且心绞痛和呼吸困难更严重，但既往卒中和肾脏疾病史以及左心室收缩功能障碍的发生率与第 1 组相似。多变量分析后，两组患者在住院期间（优势比[OR]，1.70；95%置信区间[CI]，0.63-4.58；P=0.29）、30 天（OR，1.81；95%CI，0.99-3.3；P=0.05）和 1 年（OR，1.11；95%CI，0.85-1.44；P=0.43）的死亡率以及院内主要不良心血管事件（MACE）发生率方面无显著差异。此外，与 SVG-PCI 组相比，CTO-PCI 组的操作并发症（OR，2.88；95%CI，2.38-3.47；P<0.01）和血管穿孔（OR，4.82；95%CI，2.80-8.28；P<0.01）发生率更高。但两组患者 1 年时靶血管血运重建率相似（SVG-PCI 组 5.6%，CTO-PCI 组 6.9%；P=0.08）。
在本项全国性队列研究中，CTO-PCI 主要应用于高危患者，与更多的操作并发症相关，但短期或长期死亡率以及院内 MACE 发生率相似。
