Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Division of Cardiology, Kingston Health Sciences Center, Queen's University, Ontario, Canada.
Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Cardiovasc Revasc Med. 2021 Apr;25:47-54. doi: 10.1016/j.carrev.2020.10.006. Epub 2020 Oct 19.
Percutaneous revascularization of coronary chronic total occlusions (CTO) has increased due to advances in technology and operator expertise. Quality of life (QoL) remains an important but understudied outcome following CTO revascularization. Our aim is to conduct a systematic review of the impact of CTO revascularization on QoL.
We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from January 1st, 1990 to May 17th, 2020. Studies reporting on the following QoL metrics post CTO revascularization were included: QoL subscale of the Seattle Angina Questionnaire (SAQ-QoL). The ROBINS-I tool and Cochrane risk of bias tool were used to critically assess for risk of bias.
We identified 1476 articles, of which 21 articles met inclusion criteria. Three categories of studies were identified with distinct patient populations. In the first category (1 study), CTO patients treated with either PCI or CABG compared to medical therapy had a significant improvement in SAQ-QoL compared to baseline (PCI 54.2 to 74.3; CABG 56.1 to 78.0; p < 0.05). In the second category (1 study), CTO patients compared to non-CTO patients had similar improvements in SAQ-QoL post PCI (CTO baseline 53.2 to 80.3; non-CTO baseline 56.5 to 80.6; p < 0.05). Finally, a third category with only CTO patients treated with PCI to the CTO vessel included 19 studies, all of which on average showed a significant improvement in SAQ-QoL post successful PCI, compared to non-successful PCI.
Despite the limited literature, revascularization of CTO vessel was generally associated with improvement in QoL.
Quality of life (QoL) is an important but understudied outcome following CTO revascularization. We conducted a systematic review of the impact of CTO revascularization on QoL. Despite the limitations of a lack of enough randomized control trials and the small number of studies, our systematic review highlights a trend of improvement in QoL indices after revascularization of CTO.
由于技术和操作人员专业知识的进步，经皮冠状动脉慢性完全闭塞（CTO）血运重建的数量有所增加。生活质量（QoL）仍然是 CTO 血运重建后的一个重要但研究不足的结果。我们的目的是对 CTO 血运重建对 QoL 的影响进行系统评价。
我们从 1990 年 1 月 1 日至 2020 年 5 月 17 日在三个数据库（Ovid MEDLINE、EMBASE、EBM 综述）中进行了检索。纳入报告 CTO 血运重建后以下 QoL 指标的研究：西雅图心绞痛问卷（SAQ）的 QoL 亚量表。使用 ROBINS-I 工具和 Cochrane 偏倚风险工具对偏倚风险进行批判性评估。
我们共确定了 1476 篇文章，其中 21 篇符合纳入标准。确定了具有不同患者人群的三类研究。在第一类（1 项研究）中，与药物治疗相比，接受 PCI 或 CABG 治疗的 CTO 患者的 SAQ-QoL 与基线相比有显著改善（PCI 从 54.2 至 74.3；CABG 从 56.1 至 78.0；p<0.05）。在第二类（1 项研究）中，与非 CTO 患者相比，接受 PCI 治疗的 CTO 患者的 SAQ-QoL 在 PCI 后有类似的改善（CTO 基线为 53.2 至 80.3；非 CTO 基线为 56.5 至 80.6；p<0.05）。最后，第三类仅包括接受 PCI 治疗 CTO 血管的 CTO 患者，共纳入 19 项研究，所有研究平均显示 PCI 成功后 SAQ-QoL 显著改善，而非 PCI 成功后 SAQ-QoL 改善不明显。
尽管文献有限，但 CTO 血管血运重建通常与 QoL 的改善相关。
生活质量（QoL）是 CTO 血运重建后的一个重要但研究不足的结果。我们对 CTO 血运重建对 QoL 的影响进行了系统评价。尽管缺乏足够的随机对照试验和研究数量较少的限制，但我们的系统评价强调了 CTO 血运重建后 QoL 指数改善的趋势。
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