Guo Lei, Meng Shaoke, Lv Haichen, Zhong Lei, Wu Jian, Ding Huaiyu, Xu Jiaying, Zhang Xiaoyan, 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. 2021 Apr 20;8:654730. doi: 10.3389/fcvm.2021.654730. eCollection 2021.
The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs. optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function. A total of 1,895 patients with CTOs were stratified according to LV function. Of these, 1,420 patients (74.9%) with LV ejection fraction (LVEF) >45% and 475 patients (25.1%) with LVEF ≤45% were treated with optimal MT or successful CTO percutaneous coronary intervention (PCI). A 1:1 propensity score matching (PSM) was conducted to reduce the impact of potential confounding on the outcomes. The primary outcome was the frequency of major adverse cardiac events (MACEs). Throughout a 2.6-year follow-up and after adjusting for confounders, among patients with preserved LV function, successful CTO PCI was associated with reduced incidence of MACE (14.2 vs. 23.9%, adjusted HR 0.63, 95% CI 0.48-0.83, = 0.001) compared to MT. There was no significant difference in MACE occurrence (29.6 vs. 28.9%, adjusted HR 1.05, 95% CI: 0.71-1.56, = 0.792) between successful recanalization and MT in patients with LV systolic dysfunction. The primary outcome among patients with impaired and preserved LV systolic function after PSM was similar to that from earlier findings before PSM was conducted. A significant interaction between LV function and therapeutic strategy for MACE was observed (interaction = 0.038). Compared to MT alone for management of patients with CTOs, successful CTO PCI may reduce the risk of MACE in patients with preserved LV systolic function, but not in patients with LV dysfunction.
患有左心室（LV）收缩功能障碍的冠状动脉慢性完全闭塞（CTO）患者数量可观，但这些患者的临床结局鲜有报道。本回顾性队列研究旨在调查左心室收缩功能正常和受损的CTO患者成功再通与最佳药物治疗（MT）的长期结局。总共1895例CTO患者根据左心室功能进行分层。其中，1420例左心室射血分数（LVEF）>45%的患者（74.9%）和475例LVEF≤45%的患者（25.1%）接受了最佳药物治疗或成功的CTO经皮冠状动脉介入治疗（PCI）。进行了1:1倾向评分匹配（PSM）以减少潜在混杂因素对结局的影响。主要结局是主要不良心脏事件（MACE）的发生频率。在2.6年的随访期间并在调整混杂因素后，在左心室功能正常的患者中，与MT相比，成功的CTO PCI与MACE发生率降低相关（14.2%对23.9%，调整后HR 0.63，95%CI 0.48 - 0.83，P = 0.001）。在左心室收缩功能障碍的患者中，成功再通与MT之间的MACE发生率无显著差异（29.6%对28.9%，调整后HR 1.05，95%CI：0.71 - 1.56，P = 0.792）。PSM后左心室收缩功能受损和正常的患者的主要结局与进行PSM之前的早期研究结果相似。观察到左心室功能与MACE治疗策略之间存在显著交互作用（交互作用P = 0.038）。与单独使用MT治疗CTO患者相比，成功的CTO PCI可能降低左心室收缩功能正常患者的MACE风险，但不能降低左心室功能障碍患者的MACE风险。
