经皮冠状动脉介入治疗慢性完全闭塞病变患者左心室射血分数降低的操作结果和住院转归：日本 CTO-PCI 专家登记处的亚组分析。

Procedural results and in-hospital outcomes of percutaneous coronary intervention for chronic total occlusion in patients with reduced left ventricular ejection fraction: Sub-analysis of the Japanese CTO-PCI Expert Registry.

机构信息

Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.

Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan.

出版信息

Catheter Cardiovasc Interv. 2022 Jul;100(1):30-39. doi: 10.1002/ccd.30231. Epub 2022 Jun 1.

DOI:10.1002/ccd.30231

PMID:35652164

Abstract

OBJECTIVES

To evaluate the procedural results and in-hospital outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients with reduced left ventricular ejection fraction (LVEF).

BACKGROUND

While the technical success of general CTO-PCI has improved, CTO-PCI patients with reduced LVEF remain at high-risk for adverse events.

METHODS

The data of 820 patients with LVEF ≤ 35% (Group 1), 1816 patients with LVEF = 35%-50% (Group 2), and 5503 patients with LVEF ≥ 50% (Group 3), registered in the Japanese CTO-PCI Expert Registry from January 2014 to December 2019, were retrospectively analyzed. The primary endpoint was in-hospital major adverse cardiac or cerebrovascular events (MACCEs), including death, myocardial infarction, stent thrombosis, stroke, and emergent revascularization. Secondary endpoints included procedural details, guidewire success, and technical success.

RESULTS

There were no differences in guidewire and technical success rates between the groups. In-hospital MACCEs was significantly higher in Group 1 (Group 1 vs. Group 2 vs. Group 3: 3.4% vs. 1.7% vs. 1.5%, p = 0.001) and was especially driven by death (1.3% vs. 0.3% vs. 0.1%, p < 0.001) and stroke (0.7% vs. 0.2% vs. 0.2%, p = 0.007). Multivariate analysis showed that LVEF ≤ 35% (odds ratio [OR]; 1.58, 95% confidence interval [CI]; 1.04-2.41, p = 0.03) and New York Heart Association (NYHA) class ≥ 3 (OR; 2.01, 95% CI; 1.03-3.93, p = 0.04) were predictors of in-hospital MACCEs.

CONCLUSIONS

In-hospital MACCEs were significantly higher in patients with LVEF ≤ 35%. LVEF ≤;35% and NYHA class ≥ 3 were predictors of in-hospital MACCEs after CTO-PCI.

摘要

目的

评估左心室射血分数（LVEF）降低的慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）的手术结果和住院结局。

背景

虽然一般 CTO-PCI 的技术成功率有所提高，但 LVEF 降低的 CTO-PCI 患者仍存在发生不良事件的高风险。

方法

回顾性分析了 2014 年 1 月至 2019 年 12 月在日本 CTO-PCI 专家注册中心登记的 820 例 LVEF≤35%（第 1 组）、1816 例 LVEF=35%-50%（第 2 组）和 5503 例 LVEF≥50%（第 3 组）患者的数据。主要终点为住院期间主要不良心脑血管事件（MACCE），包括死亡、心肌梗死、支架血栓形成、卒中和紧急血运重建。次要终点包括手术细节、导丝成功率和技术成功率。

结果

各组间导丝和技术成功率无差异。第 1 组住院 MACCE 发生率明显高于第 2 组和第 3 组（第 1 组 vs. 第 2 组 vs. 第 3 组：3.4% vs. 1.7% vs. 1.5%，p=0.001），且主要由死亡（1.3% vs. 0.3% vs. 0.1%，p<0.001）和卒（0.7% vs. 0.2% vs. 0.2%，p=0.007）驱动。多变量分析显示，LVEF≤35%（比值比[OR]；1.58，95%置信区间[CI]；1.04-2.41，p=0.03）和纽约心脏协会（NYHA）分级≥3（OR；2.01，95%CI；1.03-3.93，p=0.04）是住院 MACCE 的预测因素。