Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Hospitalsenheden Midt, Viborg, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Am J Cardiol. 2024 Dec 1;232:105-114. doi: 10.1016/j.amjcard.2024.09.029. Epub 2024 Oct 5.
Successful percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in the coronary arteries in the left anterior descending (LAD) artery is associated with better outcome than unsuccessful PCI. Randomized data have not found invasive treatment of non-CTO LAD lesion to be associated with better outcome. This study aimed to investigate the prognostic impact of CTO revascularization stratified on target treated vessel compared with non-CTO LAD PCI. The hypothesis was that successful PCI of LAD CTO and non-LAD CTO and unsuccessful non-LAD CTO were associated with the same prognosis as non-CTO LAD lesions, whereas patients with unsuccessful LAD CTO were associated with a poorer prognosis. The study was a population-based cohort study, including consecutive patients who underwent PCI from 2009 to 2019 in the Central Denmark Region. Patients with acute myocardial infarction within 30 days were excluded. Patients with CTO were stratified by occluded vessel and procedural success. The primary end point was long-term all-cause mortality and was calculated as a hazard ratio with a 95% confidence interval. Secondary end points were myocardial infarction and target vessel revascularization. In total, 21,141 patients were screened, 4,518 had non-CTO LAD PCI, and 1,475 had CTO PCI. The median (interquartile range) follow-up was 5.8 years (3.6 to 8.8). In the successful CTO groups, the adjusted risk for all-cause mortality was equal to patients with non-CTO LAD (LAD CTO hazard ratio [95% confidence interval] 1.14 [0.90 to 1.44], non-LAD CTO 1.09 [0.95 to 1.27]). Patients with unsuccessful LAD CTO had a higher risk than patients with non-CTO LAD, whereas unsuccessful non-LAD CTO had not (unsuccessful LAD 1.88 [1.33 to 2.65], unsuccessful non-LAD 1.26 [0.97 to 1.63]). In conclusion, successful LAD and non-LAD CTO PCI had the same prognosis as non-CTO LAD PCI, whereas only unsuccessful LAD CTO PCI had a poorer prognosis. Patients with LAD CTO are a high-risk population, and dedicated CTO trials are needed to confirm this finding and establish guideline recommendations.
经皮冠状动脉介入治疗（PCI）成功治疗慢性完全闭塞（CTO）的冠状动脉左前降支（LAD）与治疗不成功的 PCI 相比，预后更好。随机数据并未发现对非 CTO LAD 病变的侵入性治疗与更好的预后相关。本研究旨在调查与非 CTO LAD PCI 相比，根据靶血管治疗的 CTO 血运重建的预后影响。假设成功 PCI 治疗 LAD CTO 和非 LAD CTO 以及非 LAD CTO 治疗不成功与非 CTO LAD 病变具有相同的预后，而 LAD CTO 治疗不成功的患者预后较差。该研究是一项基于人群的队列研究，纳入了 2009 年至 2019 年期间在丹麦中部地区接受 PCI 的连续患者。排除了 30 天内发生急性心肌梗死的患者。根据闭塞血管和手术成功率对 CTO 患者进行分层。主要终点是长期全因死亡率，并计算为风险比和 95%置信区间。次要终点是心肌梗死和靶血管血运重建。共有 21141 名患者进行了筛选，4518 名患者进行了非 CTO LAD PCI，1475 名患者进行了 CTO PCI。中位（四分位间距）随访时间为 5.8 年（3.6 至 8.8）。在 CTO 治疗成功的患者中，全因死亡率的调整风险与非 CTO LAD 患者相当（LAD CTO 风险比[95%置信区间]1.14[0.90 至 1.44]，非 LAD CTO 为 1.09[0.95 至 1.27]）。LAD CTO 治疗不成功的患者的风险高于非 CTO LAD 患者，而非 LAD CTO 治疗不成功的患者则没有（LAD 治疗不成功 1.88[1.33 至 2.65]，非 LAD 治疗不成功 1.26[0.97 至 1.63]）。总之，LAD 和非 LAD CTO PCI 治疗成功与非 CTO LAD PCI 治疗具有相同的预后，而非 LAD CTO 治疗不成功与非 CTO LAD 病变的预后较差。LAD CTO 患者是高危人群，需要专门的 CTO 试验来证实这一发现并制定指南建议。
