Guo Lei, Ding Huaiyu, Lv Haichen, Zhang Xiaoyan, Zhong Lei, Wu Jian, Xu Jiaying, Zhou Xuchen, Huang Rongchong
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, China.
Front Cardiovasc Med. 2020 Nov 16;7:550428. doi: 10.3389/fcvm.2020.550428. eCollection 2020.
The number of coronary chronic total occlusion (CTO) patients with renal insufficiency is huge, and limited data are available on the impact of renal insufficiency on long-term clinical outcomes in CTO patients. We aimed to investigate clinical outcomes of CTO percutaneous coronary intervention (PCI) vs. medical therapy (MT) in CTO patients according to baseline renal function. In the study population of 2,497, 1,220 patients underwent CTO PCI and 1,277 patients received MT. Patients were divided into four groups based on renal function: group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m], group 2 (60 ≤ eGFR <90 ml/min/1.73 m), group 3 (30 ≤ eGFR <60 ml/min/1.73 m), and group 4 (eGFR <30 ml/min/1.73 m). Major adverse cardiac event (MACE) was the primary end point. Median follow-up was 2.6 years. With the decline in renal function, MACE ( < 0.001) and cardiac death ( < 0.001) were increased. In group 1 and group 2, MACE occurred less frequently in patients with CTO PCI, as compared to patients in the MT group (15.6% vs. 22.8%, < 0.001; 15.6% vs. 26.5%, < 0.001; respectively). However, there was no significant difference in terms of MACE between CTO PCI and MT in group 3 (21.1% vs. 28.7%, = 0.211) and group 4 (28.6% vs. 50.0%, = 0.289). MACE was significantly reduced for patients who received successful CTO PCI compared to patients with MT (16.7% vs. 22.8%, = 0.006; 16.3% vs. 26.5%, = 0.003, respectively) in group 1 and group 2. eGFR < 30 ml/min/1.73 m, age, male gender, diabetes mellitus, heart failure, multivessel disease, and MT were identified as independent predictors for MACE in patients with CTOs. Renal impairment is associated with MACE in patients with CTOs. For treatment of CTO, compared with MT alone, CTO PCI may reduce the risk of MACE in patients without chronic kidney disease (CKD). However, reduced MACE from CTO PCI among patients with CKD was not observed. Similar beneficial effects were observed in patients without CKD who underwent successful CTO procedures.
肾功能不全的冠状动脉慢性完全闭塞（CTO）患者数量众多，而关于肾功能不全对CTO患者长期临床结局影响的数据有限。我们旨在根据基线肾功能，研究CTO患者接受CTO经皮冠状动脉介入治疗（PCI）与药物治疗（MT）的临床结局。在2497例研究人群中，1220例患者接受了CTO PCI，1277例患者接受了MT。根据肾功能将患者分为四组：1组[估计肾小球滤过率（eGFR）≥90 ml/min/1.73 m²]，2组（60≤eGFR<90 ml/min/1.73 m²），3组（30≤eGFR<60 ml/min/1.73 m²）和4组（eGFR<30 ml/min/1.73 m²）。主要不良心脏事件（MACE）是主要终点。中位随访时间为2.6年。随着肾功能下降，MACE（P<0.001）和心源性死亡（P<0.001）增加。在1组和2组中，与MT组患者相比，CTO PCI患者发生MACE的频率较低（分别为15.6%对22.8%，P<0.001；15.6%对26.5%，P<0.001）。然而，3组（21.1%对28.7%，P=0.211）和4组（28.6%对50.0%，P=0.289）中CTO PCI与MT在MACE方面无显著差异。与MT患者相比，1组和2组中接受成功CTO PCI的患者MACE显著降低（分别为16.7%对22.8%，P=0.006；16.3%对26.5%，P=0.003）。eGFR<30 ml/min/1.73 m²、年龄、男性、糖尿病、心力衰竭、多支血管病变和MT被确定为CTO患者MACE的独立预测因素。肾功能损害与CTO患者的MACE相关。对于CTO的治疗，与单纯MT相比，CTO PCI可能降低无慢性肾脏病（CKD）患者的MACE风险。然而，未观察到CKD患者中CTO PCI使MACE降低。在接受成功CTO手术的无CKD患者中也观察到了类似的有益效果。
