当代慢性完全闭塞性经皮冠状动脉介入治疗成功与失败的结果

Outcomes of successful vs. failed contemporary chronic total occlusion percutaneous coronary intervention.

作者信息

Megaly Michael, Khalil Mahmoud, Basir Mir B, McEntegart Margaret B, Spratt James C, Yamane Masahisa, Tsuchikane Etsuo, Xu Bo, Alaswad Khaldoon, Brilakis Emmanouil S

机构信息

Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA.

Department of Medicine, Lincoln Medical Center, New York, NY, USA.

出版信息

Cardiovasc Interv Ther. 2022 Jul;37(3):483-489. doi: 10.1007/s12928-021-00819-x. Epub 2021 Oct 30.

DOI:10.1007/s12928-021-00819-x

PMID:34716883

Abstract

BACKGROUND

There are limited contemporary data on the impact of success vs. failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We conducted a systematic review and a meta-analysis of contemporary studies that compared the outcomes in patients who underwent successful vs. failed contemporary (2010 onwards) CTO PCI. We performed a sensitivity analysis limited to studies that started enrollment after the publication of the hybrid algorithm in 2012.

RESULTS

We included five studies with a total of 6,084 patients (successful CTO PCI n = 4,861, failed CTO PCI n = 1,223). During a median follow-up time of 12 months (range 6-60 months), successful CTO PCI was associated with a lower risk of major adverse cardiovascular events [OR: 0.61, 95% CI (0.41, 0.92), p = 0.02, I = 63%] and all-cause death [OR: 0.57, 95% CI (0.33, 0.99), p = 0.05, I = 60%]. Both groups had similar risk of myocardial infarction (MI) [OR 0.69, 95% CI (0.43, 1.10), p = 0.38, I = 80%], target vessel revascularization (TVR) [OR: 0.56, 95% CI (0.25, 1.27), p = 0.17, I = 80%], and stroke [OR: 0.52, 95% CI (0.14, 1.91), p = 0.33, I = 0%].

CONCLUSION

In contemporary practice, successful CTO PCI was associated with a lower incidence of MACE driven by lower all-cause mortality compared with failed CTO PCI at a median follow-up of 1 year.

摘要

背景

关于慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）成功与失败对治疗结果影响的当代数据有限。

方法

我们对当代研究进行了系统评价和荟萃分析，比较了接受成功与失败的当代（2010年起）CTO PCI患者的治疗结果。我们进行了一项敏感性分析，仅限于2012年混合算法发表后开始入组的研究。

结果

我们纳入了5项研究，共6084例患者（成功的CTO PCI患者n = 4861例，失败的CTO PCI患者n = 1223例）。在中位随访时间12个月（范围6 - 60个月）内，成功的CTO PCI与较低的主要不良心血管事件风险相关[比值比（OR）：0.61，95%置信区间（CI）（0.41，0.92），p = 0.02，I² = 63%]和全因死亡风险相关[OR：0.57，95% CI（0.33，0.99），p = 0.05，I² = 60%]。两组心肌梗死（MI）风险相似[OR 0.69，95% CI（0.43，1.10），p = 0.38，I² = 80%]，靶血管血运重建（TVR）风险相似[OR：0.56，95% CI（0.25，1.27），p = 0.17，I² = 80%]，中风风险相似[OR：0.52，95% CI（0.14，1.91），p = 0.33，I² = 0%]。