完全经皮血运重建对改善慢性完全闭塞合并多支血管病变患者长期预后的影响。
Effect of complete percutaneous revascularization on improving long-term outcomes of patients with chronic total occlusion and multi-vessel disease.
机构信息
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Xuan Wu District, Beijing 100050, China.
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
出版信息
Chin Med J (Engl). 2023 Apr 20;136(8):959-966. doi: 10.1097/CM9.0000000000002653. Epub 2023 Apr 4.
BACKGROUND
Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes.
METHODS
A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome.
RESULTS
At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046).
CONCLUSIONS
For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
背景
关于慢性完全闭塞（CTO）合并多血管病变（MVD）患者经皮冠状动脉介入治疗（PCI）完全与不完全血运重建的临床结局比较，目前仅有有限的数据。本研究旨在比较其临床结局。
方法
558 例 CTO 合并 MVD 患者分为最佳药物治疗（OMT）组（n=86）、不完全 PCI 组（n=327）和完全 PCI 组（n=145）。对完全和不完全 PCI 组进行倾向评分匹配（PSM）作为敏感性分析。主要结局定义为主要不良心血管事件（MACEs）的发生，不稳定型心绞痛定义为次要结局。
结果
中位随访 21 个月时，OMT、不完全 PCI 和完全 PCI 组的 MACEs 发生率分别为 43.0%（37/86）、30.6%（100/327）和 20.0%（29/145）（P=0.016），不稳定型心绞痛发生率分别为 24.4%（21/86）、19.3%（63/327）和 10.3%（15/145）（P=0.010）。与 OMT 相比，完全 PCI 与较低的 MACE 相关（校正后的危险比[HR]为 2.00；95%置信区间[CI]为 1.23-3.27；P=0.005）或不完全 PCI（校正后的 HR 为 1.58；95% CI 为 1.04-2.39；P=0.031）。PSM 敏感性分析显示，在完全 PCI 和不完全 PCI 组之间，MACEs 的发生率也具有相似的结果（20.5%[25/122]比 32.6%[62/190]，校正后的 HR 为 0.55；95% CI 为 0.32-0.96；P=0.035）和不稳定型心绞痛（10.7%[13/122]比 20.5%[39/190]，校正后的 HR 为 0.48；95% CI 为 0.24-0.99；P=0.046）。
结论
对于 CTO 合并 MVD 的治疗，与不完全 PCI 和 OMT 相比，完全 PCI 降低了长期 MACEs 和不稳定型心绞痛的风险。在 CTO 和非 CTO 病变中进行完全 PCI 可能有助于改善 CTO 合并 MVD 患者的预后。
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