Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
PLoS One. 2024 Jul 15;19(7):e0307264. doi: 10.1371/journal.pone.0307264. eCollection 2024.
Understanding the prognostic impact of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) is crucial for patient management. Previous studies have primarily been studying prognostic impact of successful versus unsuccessful CTO PCI. This study investigated the prognostic impact of successful and unsuccessful percutaneous coronary intervention (PCI) of chronic total occluded coronary arteries (CTO) with non-CTO PCI as reference.
Patients treated with PCI from 2009 to 2019 in the Central Region of Denmark were included in a population-based cohort study. We compared successful and unsuccessful CTO PCI with non-CTO PCI. Exclusion criteria was myocardial infarction within 30 days. Primary outcome was difference in a composite major adverse cardio- and cerebrovascular events (MACCE) encompassing all-cause death, any myocardial infarction, stroke, hospitalization for heart failure or revascularization tracked via nationwide registries.
Of 21,141 screened patients, 10,638 were enrolled: 9,065 underwent non-CTO PCI, 1,300 had successful CTO PCI, and 273 had unsuccessful CTO PCI. Median follow-up time was 5.9 [3.5;9.0] years and 4,750 MACCEs were recorded. Compared to non-CTO PCI, the adjusted MACCE rate for successful CTO PCI was equivalent (Hazard Ratio (HR): 0.98, 95% Confidence Interval (CI): 0.90-1.07, p = 0.71). In contrast, unsuccessful CTO PCI was associated with a higher MACCE rate (HR: 1.22, 95% CI: 1.04-1.43, p<0.01). HR was adjusted for age, body-mass index, previous revascularization, smoking, kidney disease, two or three-vessel disease, left ventricular ejection fraction, diabetes and comorbidities.
The pre-specified hypothesis was accepted. Successful CTO PCI was associated with equivalent long-term outcomes as non-CTO PCI, and unsuccessful CTO PCI was identified as a high-risk group associated to worse outcomes.
了解经皮冠状动脉介入治疗（PCI）在慢性完全闭塞（CTO）中的预后影响对于患者管理至关重要。先前的研究主要集中在成功与不成功的 CTO PCI 的预后影响上。本研究以非 CTO PCI 为参照，探讨了成功和不成功的慢性完全闭塞冠状动脉（CTO）经皮冠状动脉介入治疗（PCI）的预后影响。
纳入了 2009 年至 2019 年在丹麦中部地区接受 PCI 治疗的患者进行了一项基于人群的队列研究。我们比较了成功和不成功的 CTO PCI 与非 CTO PCI。排除标准为 30 天内心肌梗死。主要结局是通过全国性登记处追踪的全因死亡、任何心肌梗死、卒中和心力衰竭住院或血运重建的复合主要不良心脑血管事件（MACCE）的差异。
在 21141 名筛选患者中，有 10638 名入选：9065 名接受非 CTO PCI，1300 名成功 CTO PCI，273 名不成功 CTO PCI。中位随访时间为 5.9 [3.5；9.0]年，记录了 4750 例 MACCE。与非 CTO PCI 相比，成功 CTO PCI 的调整后的 MACCE 发生率相当（风险比（HR）：0.98，95%置信区间（CI）：0.90-1.07，p=0.71）。相比之下，不成功的 CTO PCI 与更高的 MACCE 发生率相关（HR：1.22，95% CI：1.04-1.43，p<0.01）。HR 经过年龄、体重指数、既往血运重建、吸烟、肾脏疾病、两血管或三血管疾病、左心室射血分数、糖尿病和合并症的调整。
预先指定的假设被接受。成功的 CTO PCI 与非 CTO PCI 的长期预后相当，而不成功的 CTO PCI 被确定为与较差结局相关的高危人群。
