Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Am J Cardiol. 2024 Mar 1;214:59-65. doi: 10.1016/j.amjcard.2023.12.052. Epub 2024 Jan 7.
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
虽然急性冠状动脉综合征（ACS）合并慢性完全闭塞（CTO）与更大的风险相关，但 CTO 合并稳定型冠状动脉疾病（CAD）患者的预后仍不清楚。本研究旨在探讨合并和不合并 CTO 的稳定型 CAD 患者不良事件发生率。在 3597 例接受心脏导管检查的稳定型 CAD 患者（>50%冠状动脉管腔狭窄）中，评估了全因死亡率、心血管死亡率以及心血管死亡、心肌梗死和心力衰竭住院的复合主要不良心脏事件（MACE）发生率。使用 Cox 比例风险和 Fine 和 Gray 亚分布风险模型，在调整协变量后比较了患者亚组的无事件生存率。在校正人口统计学和临床特征后，CTO 患者的事件发生率高于无 CTO 患者（心血管死亡风险比[HR]1.29，95%置信区间[CI]1.05 至 1.57，p = 0.012）。CTO 血运重建患者的事件发生率低于无 CTO 血运重建患者（心血管死亡 HR 0.43，CI 0.26 至 0.70，p = 0.001）。与无 CTO 患者相比，未血运重建的 CTO 患者风险尤其大（心血管死亡 HR 1.52，CI 1.25 至 1.84，p<0.001）。此外，血运重建的 CTO 患者与无 CTO 的 CAD 患者的事件发生率相似。CTO 患者的不良心血管事件发生率高于无 CTO 的严重 CAD 患者。未血运重建的 CTO 患者风险最大。
