Yang Dong Ju, Park Soohyung, Rha Seung-Woon, Choi Se Yeon, Choi Cheol Ung, Choi Byoung Geol
Department of Cardiology, Cheongju St. Mary's Hospital, Cheongju, Republic of Korea.
Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
Heart Vessels. 2025 May;40(5):380-390. doi: 10.1007/s00380-024-02484-5. Epub 2024 Nov 29.
To compare the long-term prognostic effect of complete percutaneous coronary intervention (PCI) on cardiovascular events in chronic total occlusion (CTO) patients with the multi-vessel disease (MVD) compared with medical therapy (MT). We enrolled 441 patients with CTO and MVD who underwent PCI. The study population was divided into the CTO-PCI (n = 231) and the CTO-MT (n = 210) groups. Active PCI for non-CTO lesions was permitted in both groups. The primary endpoint was defined as the composite of all-cause death or myocardial infarction (MI). The primary endpoint occurred more frequently in the CTO-MT group (13.5%) than in the CTO-PCI group (4.7%; P = 0.002). However, the target vessel revascularization (TVR), as a secondary endpoint, occurred more in the CTO-PCI group (16.3% vs. 5.5%, P = 0.001). After propensity score matching (PSM) analysis, the primary endpoint was higher in the CTO-MT group (12.6%) than in the PCI group (2.3%): all-cause death (8.4% vs. 2.3%, P = 0.042) and MI (4.3% vs. 0.0%, P = 0.023). Moreover, TVR of the CTO lesions occurred more frequently in the CTO-PCI group (18.1% vs. 6.8%, P = 0.009). Significant improvement in the left ventricular ejection fraction (LVEF) was observed in both groups. According to the results of the subgroup analysis, CTO-PCI may be more effective in patients with diabetes, preserved LVEF (> 50%), and well-developed collateral vessels (> grade II). In this study, complete revascularization in CTO with MVD reduced the incidence of all-cause death, MI, and a composite of both over a 5 year follow-up compared to medical treatment for CTO lesions.
为比较完全经皮冠状动脉介入治疗（PCI）与药物治疗（MT）对慢性完全闭塞（CTO）合并多支血管病变（MVD）患者心血管事件的长期预后影响。我们纳入了441例接受PCI的CTO合并MVD患者。研究人群分为CTO-PCI组（n = 231）和CTO-MT组（n = 210）。两组均允许对非CTO病变进行积极的PCI治疗。主要终点定义为全因死亡或心肌梗死（MI）的复合终点。主要终点在CTO-MT组（13.5%）的发生频率高于CTO-PCI组（4.7%；P = 0.002）。然而，作为次要终点的靶血管血运重建（TVR）在CTO-PCI组的发生率更高（16.3%对5.5%，P = 0.001）。经过倾向评分匹配（PSM）分析后，CTO-MT组的主要终点（12.6%）高于PCI组（2.3%）：全因死亡（8.4%对2.3%，P = 0.042）和MI（4.3%对0.0%，P = 0.023）。此外，CTO病变的TVR在CTO-PCI组的发生频率更高（18.1%对6.8%，P = 0.009）。两组的左心室射血分数（LVEF）均有显著改善。根据亚组分析结果，CTO-PCI在糖尿病、LVEF保留（>50%）和侧支血管发育良好（>II级）的患者中可能更有效。在本研究中，与CTO病变的药物治疗相比，CTO合并MVD的完全血运重建在5年随访期间降低了全因死亡、MI以及两者复合终点的发生率。
