Kim Tae Oh, Kim SeHee, Kim Min-Ju, Kang Do-Yoon, Lee Pil Hyung, Kang Soo-Jin, Lee Cheol Whan, Kim Young-Hak, Lee Jong-Young, Lee Seung-Whan
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Biostatistics, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Heliyon. 2024 Nov 12;10(23):e40326. doi: 10.1016/j.heliyon.2024.e40326. eCollection 2024 Dec 15.
The impact of complete revascularization (CR), achieved through the recanalization of coronary chronic total occlusions (CTOs), on long-term patient outcomes remains uncertain. To evaluate this in patients who achieved CR after CTO-PCI with those who did not due to deferred CTO-PCI, the Asan Medical Center Registry was reviewed to identify coronary artery disease (CAD) patients with CTOs treated between January 2003 and December 2018. Patients were included with single-vessel disease with CTO and with multivessel disease who had undergone revascularization for non-CTO lesions. These subjects were divided into those who achieved CR with CTO-PCI and those who did not due to deferred CTO-PCI. Their outcomes were compared following 1:1 propensity score matching. Of the 2746 enrolled CAD patients with CTOs, 1837 achieved CR with CTO-PCI and 909 did not. Propensity score matching yielded 653 patient pairs. The CR-achieving group had a significantly lower 10-year risk of the primary composite outcome of death, myocardial infarction, stroke, or repeat revascularization (hazard ratio [HR]: 0.57; 95 % confidence interval [CI]: 0.46-0.72; P < 0.001), as well as significantly lower risks of death (HR: 0.66; 95 % CI: 0.51-0.87; P = 0.003) and repeat revascularization (HR: 0.67; 95 % CI: 0.48-0.95; P = 0.023). CR was beneficial in all subgroups, including patients with major cardiovascular risk factors such as older age, hypertension, diabetes, and advanced CAD. Compared with incomplete revascularization, CR may significantly reduce the 10-year incidence of major adverse cardiac events in patients with CTO.
通过冠状动脉慢性完全闭塞病变（CTO）再通实现的完全血运重建（CR）对患者长期预后的影响仍不确定。为了评估CTO经皮冠状动脉介入治疗（CTO-PCI）后实现CR的患者与因延迟CTO-PCI而未实现CR的患者的情况，我们回顾了峨山医疗中心登记处的数据，以确定2003年1月至2018年12月期间接受治疗的患有CTO的冠状动脉疾病（CAD）患者。纳入的患者为患有CTO的单支血管疾病患者以及因非CTO病变接受血运重建的多支血管疾病患者。这些受试者被分为通过CTO-PCI实现CR的患者和因延迟CTO-PCI而未实现CR的患者。在1:1倾向评分匹配后比较他们的预后。在2746名登记的患有CTO的CAD患者中，1837名通过CTO-PCI实现了CR，909名未实现。倾向评分匹配产生了653对患者。实现CR的组发生死亡、心肌梗死、中风或再次血运重建的主要复合结局的10年风险显著更低（风险比[HR]：0.57；95%置信区间[CI]：0.46-0.72；P<0.001），死亡风险（HR：0.66；95%CI：0.51-0.87；P=0.003）和再次血运重建风险（HR：0.67；95%CI：0.48-0.95；P=0.023）也显著更低。CR在所有亚组中都是有益的，包括年龄较大、高血压、糖尿病和晚期CAD等主要心血管危险因素的患者。与不完全血运重建相比，CR可能显著降低CTO患者主要不良心脏事件的10年发生率。
