Department of Cardiology Aarhus University Hospital Aarhus Denmark.
Institute of Clinical Medicine Aarhus University Aarhus Denmark.
J Am Heart Assoc. 2023 Oct 17;12(20):e030989. doi: 10.1161/JAHA.123.030989. Epub 2023 Oct 13.
Background Fifteen percent of patients with coronary artery disease undergoing angiography have a chronic total occlusion (CTO). The current study aimed to investigate the long-term prognosis after successful and unsuccessful CTO percutaneous coronary intervention (PCI) compared with PCI for non-CTO lesions. Methods and Results The current study was designed as an observational, region-wide, register-based cohort study enrolling all patients undergoing PCI in the Central Region of Denmark in 2009 to 2019. Patients were stratified into non-CTO, successful CTO, and unsuccessful CTO revascularization. Patients were followed until an event or January 1, 2022. The primary end point was all-cause mortality. In 21 141 patients enrolled, 2108 underwent CTO PCI. Clinical presentation was acute coronary syndrome in 11 879 patients and chronic coronary syndrome in 7887 patients. After a median of 5.7 years (interquartile range, 3.3-8.8), long-term all-cause mortality was higher after CTO PCI compared with non-CTO PCI, but the difference was statistically insignificant when adjusting for clinical factors (unadjusted hazard ratio [HR], 1.19 [95% CI, 1.09-1.29], adjusted HR, 1.08 [95% CI, 0.97-1.20]; =0.165). After successful CTO PCI, no difference compared with non-CTO PCI was observed (unadjusted HR, 0.99 [95% CI, 0.90-1.10], adjusted HR, 0.99 [95% CI, 0.87-1.12]; =0.873). After unsuccessful CTO PCI, long-term all-cause mortality was higher than non-CTO PCI (unadjusted HR, 1.82 [95% CI, 1.59-2.08], adjusted HR, 1.35 [95% CI, 1.13-1.63]; <0.001). Conclusions Patients undergoing PCI for CTO have elevated long-term mortality compared with patients without CTO. Successful opening of the CTO(s) is associated with equal mortality compared with non-CTO PCI. In contrast, failed CTO PCI is associated with worse long-term mortality. These findings suggest the need for CTO programs with high success rates and low complication rates.
接受血管造影的冠状动脉疾病患者中有 15%存在慢性完全闭塞（CTO）。本研究旨在比较 CTO 经皮冠状动脉介入治疗（PCI）成功和不成功与非 CTO 病变 PCI 的长期预后。
本研究设计为一项观察性、全区域、基于登记的队列研究，纳入 2009 年至 2019 年在丹麦中部地区接受 PCI 的所有患者。患者分为非 CTO、成功 CTO 和不成功 CTO 血运重建。患者随访至发生事件或 2022 年 1 月 1 日。主要终点为全因死亡率。在纳入的 21087 例患者中，2108 例行 CTO PCI。11879 例患者的临床表现为急性冠状动脉综合征，7887 例患者为慢性冠状动脉综合征。中位随访 5.7 年后（四分位距，3.3-8.8），与非 CTO PCI 相比，CTO PCI 后长期全因死亡率更高，但调整临床因素后差异无统计学意义（未调整的危险比[HR]，1.19 [95%CI，1.09-1.29]，调整的 HR，1.08 [95%CI，0.97-1.20]；=0.165）。成功 CTO PCI 后与非 CTO PCI 无差异（未调整的 HR，0.99 [95%CI，0.90-1.10]，调整的 HR，0.99 [95%CI，0.87-1.12]；=0.873）。不成功 CTO PCI 后，全因死亡率高于非 CTO PCI（未调整的 HR，1.82 [95%CI，1.59-2.08]，调整的 HR，1.35 [95%CI，1.13-1.63]；<0.001）。
与无 CTO 的患者相比，接受 CTO PCI 的患者有更高的长期死亡率。成功开通 CTO 与非 CTO PCI 死亡率相等。相比之下，CTO PCI 失败与长期死亡率恶化相关。这些发现表明需要 CTO 计划具有高成功率和低并发症率。
