Holck Emil Nielsen, Winther Naja Stausholm, Mogensen Lone Juul Hune, Christiansen Evald Høj
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Front Cardiovasc Med. 2022 May 26;9:849942. doi: 10.3389/fcvm.2022.849942. eCollection 2022.
Revascularization of patients with chronic total occluded coronary arteries (CTO) is recommended if they have symptoms despite medical treatment. The cost-effectiveness of treatment with percutaneous coronary intervention (PCI) was investigated in this cohort study.
The study was designed as a cohort study enrolling all patients undergoing PCI for a CTO in the Central Region of Denmark and recorded in the EUROCTO database. Major adverse cardio- and cerebrovascular events (MACCE) and admissions for cardiac symptoms were collected in the Western Denmark Heart Registry and through medical Journal Audits. Exposure was defined as successful revascularization of all CTO lesions compared with having one or more remaining CTOs after PCI attempt(s). Cost-effectiveness was evaluated as the net benefit (NB) at the patient level 3 years after treatment and through cost-effectiveness planes. The cost was defined as the cumulative cost of the index procedure and admissions due to MACCE and cardiac symptoms. Effectiveness was defined as the difference in MACCE for the primary analysis and the difference in death and symptomatic admissions for the secondary.
Between 2009 and 2019, 441 patients with ≥ 3 years of follow-up were treated with PCI for at least one CTO lesion (342 in the successful arm and 99 in the unsuccessful arm). The technical success rate was 85.4%. In total, 155 MACCE and 184 symptomatic admissions occurred in the follow-up period. The mean total cost was EUR 11.719 (11.034; 12.406) in the successful group vs. EUR 13.565 (11.899; 15,231) ( = 0.02) in the unsuccessful group. Net-benefit was EUR 1.846 (64; 3,627) after successful revascularization for MACCE. The adjusted analysis found an NB of EUR 1,481 (-118; 3,079). Bootstrap estimates showed cost-effectiveness planes in favor of successful revascularization.
Patients fully revascularized for all CTO lesions had a more cost-efficient treatment. However, results need confirmation in a randomized controlled trial due to the risk of residual confounding after adjustment.
对于慢性完全闭塞冠状动脉（CTO）患者，若经药物治疗仍有症状，则建议进行血运重建。本队列研究调查了经皮冠状动脉介入治疗（PCI）的成本效益。
本研究设计为一项队列研究，纳入丹麦中部地区所有接受CTO-PCI治疗的患者，并记录在EUROCTO数据库中。丹麦西部心脏登记处及通过医学期刊审核收集主要的心脑血管不良事件（MACCE）和心脏症状住院情况。暴露定义为所有CTO病变成功血运重建，与PCI尝试后仍有一个或多个CTO病变的情况相比。成本效益评估为治疗后3年患者层面的净效益（NB），并通过成本效益平面进行评估。成本定义为首次手术及因MACCE和心脏症状住院的累积成本。有效性定义为主要分析中MACCE的差异，次要分析中死亡和有症状住院的差异。
2009年至2019年期间，441例随访时间≥3年的患者接受了至少一处CTO病变的PCI治疗（成功组342例，失败组99例）。技术成功率为85.4%。随访期间共发生155例MACCE和184例有症状住院。成功组的平均总成本为11719欧元（11034；12406），失败组为13565欧元（11899；15231）（P = 0.02）。MACCE成功血运重建后的净效益为1846欧元（64；3627）。校正分析发现净效益为1481欧元（-118；3079）。自抽样估计显示成本效益平面有利于成功血运重建。
所有CTO病变均成功血运重建的患者治疗成本效益更高。然而，由于校正后仍存在残余混杂风险，结果需要在随机对照试验中得到证实。
