左心室射血分数降低患者慢性完全闭塞性经皮冠状动脉介入治疗的结果
Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction.
作者信息
Simsek Bahadir, Kostantinis Spyridon, Karacsonyi Judit, Alaswad Khaldoon, Karmpaliotis Dimitri, Masoumi Amirali, Jaffer Farouc A, Doshi Darshan, Khatri Jaikirshan, Poommipanit Paul, Gorgulu Sevket, Goktekin Omer, Krestyaninov Oleg, Davies Rhian, ElGuindy Ahmed, Jefferson Brian K, Patel Taral N, Patel Mitul, Chandwaney Raj H, Mashayekhi Kambis, Galassi Alfredo R, Rangan Bavana V, Brilakis Emmanouil S
机构信息
Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
出版信息
Catheter Cardiovasc Interv. 2022 Mar;99(4):1059-1064. doi: 10.1002/ccd.30097. Epub 2022 Jan 23.
BACKGROUND
The relationship between left ventricular ejection fraction (LVEF) and the success and safety of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
METHODS
We examined the clinical characteristics and outcomes of CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO) after stratifying patients by LVEF (≤35%, 36%-49%, and ≥50%).
RESULTS
A total of 7827 CTO PCI procedures with LVEF data were included. Mean age was 64 ± 10 years, 81% were men, 43% had diabetes mellitus, 61% had prior PCI, 45% had prior myocardial infarction, and 29% had prior coronary artery bypass graft surgery. Technical success was similar in the three LVEF strata: 85%, 86%, and 87%, p = 0.391 for LVEF ≤35%, 36%-49%, and ≥50%, respectively. In-hospital mortality was higher in lower LVEF patients (1.1%, 0.4%, and 0.3%, respectively, p = 0.001). In-hospital major adverse cardiovascular events (MACE) were numerically higher in lower EF patients (2.7%, 2.1%, and 1.9%, p = 0.271). At a median follow-up of 2 months (interquartile range: 19-350 days), patients with lower LVEF continued to have higher mortality (4.9%, 3.2%, and 1.4%, p < 0.001) while the MACE rates were similar (9.3%, 9.6%, and 7.4%, p = 0.172).
CONCLUSION
CTO PCI can be performed with high technical success in patients with reduced LVEF but is associated with higher in-hospital and post-discharge mortality.
背景
左心室射血分数（LVEF）与冠状动脉慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成功率及安全性之间的关系研究较少。
方法
我们在CTO介入治疗前瞻性全球注册研究（PROGRESS-CTO）中，根据LVEF（≤35%、36%-49%和≥50%）对患者进行分层，研究CTO PCI的临床特征和结果。
结果
共纳入7827例有LVEF数据的CTO PCI手术。平均年龄为64±10岁，81%为男性，43%患有糖尿病，61%曾接受过PCI，45%曾发生过心肌梗死，29%曾接受过冠状动脉旁路移植术。三个LVEF分层的技术成功率相似：LVEF≤35%、36%-49%和≥50%的患者分别为85%、86%和87%，p = 0.391。LVEF较低的患者住院死亡率较高（分别为1.1%、0.4%和0.3%，p = 0.001）。LVEF较低的患者住院期间主要不良心血管事件（MACE）在数值上较高（分别为2.7%、2.1%和1.9%，p = 0.271）。在中位随访2个月（四分位间距：19-350天）时，LVEF较低的患者死亡率持续较高（分别为4.9%、3.2%和1.4%，p < 0.001）而MACE发生率相似（分别为9.3%、9.
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