Zhang Dongfeng, Nan Nan, Xue Yuguo, Zhang Mingduo, Tian Jinfan, Chen Changzhe, Zhang Min, Song Xiantao
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.
Cardiol J. 2024;31(1):15-23. doi: 10.5603/CJ.a2022.0010. Epub 2022 Mar 4.
The optimal treatment strategy of chronic total occlusion (CTO) is currently debated. This meta-analysis aimed to evaluate the long-term clinical outcomes of successful percutaneous coronary intervention (PCI) of CTO.
Electronic databases were searched for studies comparing long-term outcomes between successful PCI in patients with CTO using drug-eluting stents and failed procedures. Meta-analysis was conducted with major adverse cardiac events (MACE) and all-cause mortality during the longest follow-up as endpoints. The combined hazard ratios (HRs) were applied to assess the correlation between successful CTO PCI and MACE/all-cause mortality.
Eight studies consisting of 6,211 patients published between 2012 and 2020 met our inclusion criteria, and the CTO PCI success rate was 81.2%. Patients in the failed group were much older, and more likely to have morbidities (hypertension and prior myocardial infarction), reduced left ventricular ejection fraction, and severe lesion characteristics (multivessel disease and moderate/severe calcification). Pooled results indicated that successful CTO PCI was significantly associated with prognosis. Compared to failed recanalization, patients receiving successful procedures had an improved MACE (HR: 0.50, 95% CI: 0.40-0.61, p < 0.001). Subgroup analyses further revealed the prognostic value of successful CTO PCI. However, no difference was observed regarding all-cause mortality (HR: 0.79, 95% CI: 0.61-1.02, p = 0.074).
The present study showed that CTO recanalization was associated with improved long-term outcomes. However, randomized trials are needed to confirm the results due to the mismatch of baseline characteristics.
目前慢性完全闭塞病变（CTO）的最佳治疗策略存在争议。本荟萃分析旨在评估成功的CTO经皮冠状动脉介入治疗（PCI）的长期临床结局。
检索电子数据库，查找比较使用药物洗脱支架成功进行CTO PCI的患者与手术失败患者长期结局的研究。以最长随访期间的主要不良心脏事件（MACE）和全因死亡率为终点进行荟萃分析。应用合并风险比（HR）评估成功的CTO PCI与MACE/全因死亡率之间的相关性。
2012年至2020年间发表的8项研究共纳入6211例患者，符合我们的纳入标准，CTO PCI成功率为81.2%。失败组患者年龄更大，更有可能患有多种疾病（高血压和既往心肌梗死），左心室射血分数降低，且病变特征严重（多支血管病变和中度/重度钙化）。汇总结果表明，成功的CTO PCI与预后显著相关。与再通失败相比，接受成功手术的患者MACE改善（HR：0.50，95%CI：0.40-0.61，p<0.001）。亚组分析进一步揭示了成功的CTO PCI的预后价值。然而，在全因死亡率方面未观察到差异（HR：0.79，95%CI：0.61-1.02，p=0.074）。
本研究表明，CTO再通与改善长期结局相关。然而，由于基线特征不匹配，需要进行随机试验来证实结果。
