Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Clin Res Cardiol. 2024 Jul;113(7):987-994. doi: 10.1007/s00392-023-02298-x. Epub 2023 Sep 11.
Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients' outcome. In a nationwide sample, we sought to analyze trends of patients' characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany.
We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8-839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged ≥ 18 years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (β 3.48 [95% CI 3.44-3.52]; p < 0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β - 0.60 [95% CI - 0.82 to - 0.39]; p < 0.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73-0.90]; p < 0.001). Significant predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock.
Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization.
最近，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）的介入技术和材料有了显著发展。然而，目前尚不清楚这一进展是否提高了治疗成功率和患者的预后。在全国范围内的样本中，我们试图分析德国 CTO 血运重建患者的特征、并发症和院内病死率的变化趋势。
我们分析了德国 2009 年至 2020 年所有接受双注射 CTO 再通术（OPS 操作代码：8-839.9）的冠状动脉疾病（ICD 编码 I25）患者的特征、治疗和院内结局数据。在此期间，德国医院共收治了 4998457 名年龄≥18 岁的冠心病住院患者。其中，52879 名患者（1.1%）接受了 CTO 再通术。CTO PCI 的年例数从 2009 年的 1263 例增加到 2020 年的 6435 例（β3.48[95%CI 3.44-3.52]；p<0.001），同时病死率显著降低（2009 年为 2.2%，2020 年为 1.4%；β-0.60[95%CI-0.82 至-0.39]；p<0.001）。总的来说，52879 名 CTO 再通患者中有 754 名（1.4%）在住院期间死亡，院内病死率随年龄呈指数增长（β0.82[95%CI 0.73-0.90]；p<0.001）。OR>3 的院内病死率的显著预测因素为癌症、中风、血心包、急性肾衰竭、肺栓塞和休克。
德国 CTO 手术数量从 2009 年到 2020 年逐年增加，同时病死率呈反比下降。我们的发现可能有助于更多地关注接受 CTO 再通治疗的住院患者院内病死率的预测因素。
