Hadžibegović Irzal, Jurin Ivana, Kovačić Mihajlo, Letilović Tomislav, Lisičić Ante, Blivajs Aleksandar, Mišković Domagoj, Jurišić Anđela, Rudež Igor, Manola Šime
Department for Cardiovascular Diseases, Dubrava University Hospital, 10000 Zagreb, Croatia.
Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University, 31000 Osijek, Croatia.
J Clin Med. 2024 Nov 24;13(23):7094. doi: 10.3390/jcm13237094.
: Patients with non-infarct-related artery chronic total occlusion (non-IRA CTO) found during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACSs) are not rare and have worse clinical outcomes. We aimed to analyze their long-term clinical outcomes in regard to clinical characteristics, revascularization strategies, and adherence to medical therapy. : The dual-center ACS registry of patients treated from Jan 2017 to May 2023 was used to identify 1950 patients with timely PCI in ACS who survived to discharge with documented adequate demographic, clinical, and angiographic characteristics, treatment strategies, and medical therapy adherence during a median follow-up time of 49 months. : There were 171 (9%) patients with non-IRA CTO. In comparison to patients without non-IRA CTO, they were older, with more diabetes mellitus (DM), higher Syntax scores (median 27.5 vs. 11.5), and lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 50% vs. 55%). There was also a lower proportion of patients with high adherence to medical therapy (32% vs. 46%). Patients with non-IRA CTO had significantly higher cardiovascular mortality during follow-up (18% vs. 8%, RR 1.87, 95% CI 1.27-2.75). After adjusting for relevant clinical and treatment characteristics in a multivariate Cox regression analysis, only lower LVEF, worse renal function, the presence of DM, and lower adherence to medical therapy were independently associated with higher cardiovascular mortality during follow-up, with low adherence to medical therapy as the strongest predictor (RR 3.18, 95% CI 1.76-5.75). Time to cardiovascular death was significantly lower in patients who did not receive non-IRA CTO revascularization, although CTO revascularization did not show independent association with survival in the multivariate analysis. : Patients with non-IRA CTO found during ACS treatment have more unfavorable clinical characteristics, worse adherence to medical therapy, and higher cardiovascular mortality. They need a more scrutinized approach during follow-up to increase adherence to optimal medical therapy and to receive revascularization of the non-IRA CTO whenever it is clinically indicated and reasonably achievable without excess risks.
在急性冠状动脉综合征（ACS）的经皮冠状动脉介入治疗（PCI）过程中发现的非梗死相关动脉慢性完全闭塞（non-IRA CTO）患者并不少见，且临床结局较差。我们旨在分析其在临床特征、血运重建策略和药物治疗依从性方面的长期临床结局。
使用2017年1月至2023年5月接受治疗的患者的双中心ACS登记数据，确定1950例在ACS中接受及时PCI且存活至出院的患者，这些患者有记录的充分人口统计学、临床和血管造影特征、治疗策略以及在中位随访时间49个月期间的药物治疗依从性。
有171例（9%）患者存在non-IRA CTO。与无non-IRA CTO的患者相比，他们年龄更大，糖尿病（DM）更多，Syntax评分更高（中位数27.5对11.5），出院时左心室射血分数（LVEF）更低（中位数LVEF 50%对55%）。药物治疗高依从性的患者比例也更低（32%对46%）。non-IRA CTO患者在随访期间的心血管死亡率显著更高（18%对8%，RR 1.87, 95% CI 1.27 - 2.75）。在多变量Cox回归分析中对相关临床和治疗特征进行调整后，仅较低的LVEF、较差的肾功能、DM的存在以及较低的药物治疗依从性与随访期间较高的心血管死亡率独立相关，其中药物治疗依从性低是最强的预测因素（RR 3.18, 95% CI 1.76 - 5.75）。未接受non-IRA CTO血运重建的患者心血管死亡时间显著更短，尽管在多变量分析中CTO血运重建与生存未显示出独立关联。
在ACS治疗期间发现的non-IRA CTO患者具有更不利 的临床特征、更差的药物治疗依从性和更高的心血管死亡率。他们在随访期间需要更仔细的处理方法，以提高对最佳药物治疗的依从性，并在临床指征明确且合理可行且无过多风险时接受non-IRA CTO的血运重建。
