Megaly Michael, Zakhour Samer, Karacsonyi Judit, Basir Mir B, Kunkel Katherine, Gupta Ankur, Neupane Saroj, Alqarqaz Mohammad, Brilakis Emmanouil S, Alaswad Khaldoon
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Am J Cardiol. 2023 Apr 15;193:75-82. doi: 10.1016/j.amjcard.2023.01.049. Epub 2023 Mar 4.
The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center. Outcomes included in-hospital and long-term major adverse cardiovascular events (MACEs) and changes in left ventricular ejection fraction (LVEF). We performed a subgroup analysis of patients with ischemic cardiomyopathy, defined as an LVEF of 40% or less. From December 2014 to February 2021, 237 patients underwent LAD CTO PCI. The technical success rate was 97.4%, and the in-hospital MACE rate was 5.4%, A landmark analysis after hospital discharge showed an overall survival of 92% and 85% MACE-free survival at 2 years. There was no difference in overall survival or MACE-free survival between those who had ischemic cardiomyopathy versus those who did not. In patients with ischemic cardiomyopathy, LAD CTO PCI was associated with significant improvement in LVEF (10.9% at 9 months), which was further pronounced when these patients had a proximal LAD CTO and were on optimal medical therapy (14% at 6 months). In a single high-volume center, LAD CTO PCI was associated with 92% overall survival at 2 years, with no difference in survival between patients with or without ischemic cardiomyopathy. LAD CTO PCI was associated with an absolute 10% increase in LVEF at 9 months in patients with ischemic cardiomyopathy.
左前降支动脉（LAD）供血的心肌区域较大。LAD慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的疗效研究有限。我们对在一个高容量单中心接受LAD CTO PCI的所有患者进行了回顾性分析。结果包括住院期间和长期的主要不良心血管事件（MACE）以及左心室射血分数（LVEF）的变化。我们对缺血性心肌病患者（定义为LVEF为40%或更低）进行了亚组分析。2014年12月至2021年2月，237例患者接受了LAD CTO PCI。技术成功率为97.4%，住院期间MACE发生率为5.4%，出院后的标志性分析显示2年时总体生存率为92%，无MACE生存率为85%。有缺血性心肌病的患者与无缺血性心肌病的患者在总体生存率或无MACE生存率方面没有差异。在缺血性心肌病患者中，LAD CTO PCI与LVEF显著改善相关（9个月时为10.9%），当这些患者为LAD近端CTO且接受最佳药物治疗时，改善更为明显（6个月时为14%）。在一个高容量单中心，LAD CTO PCI与2年时92%的总体生存率相关，有或无缺血性心肌病的患者生存率无差异。缺血性心肌病患者在9个月时LAD CTO PCI与LVEF绝对增加10%相关。
