冠状动脉慢性完全闭塞影响射血分数轻度降低的心力衰竭患者的长期预后。
Coronary Chronic Total Occlusions Affect Long-Term Prognosis in Heart Failure With Mildly Reduced Ejection Fraction.
作者信息
Behnes Michael, Schmidberger Moritz, Mashayekhi Kambis, Vadalà Giuseppe, Moroni Alice, Guiterrez-Chico Juan-Luis, Ayoub Mohamed, Christiansen Evald Høj, Pyxaras Stylianos, Bufe Alexander, Krötz Florian, Schmitt Alexander, Lau Felix, Reinhardt Marielen, Forner Jan, Dudda Jonas, Abel Noah, Hoepfner Mila Kathrin, Aubel Cedric, Abumayyaleh Mohammad, Weidner Kathrin, Akin Ibrahim, Schupp Tobias
机构信息
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University Mannheim Germany.
Department of Internal Medicine and Cardiology Mediclin Heart Centre Lahr Lahr Germany.
出版信息
J Am Heart Assoc. 2025 Sep 2;14(17):e042368. doi: 10.1161/JAHA.125.042368. Epub 2025 Aug 22.
BACKGROUND
This study investigates the prevalence and prognostic impact of coronary chronic total occlusions (CTO) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Although coronary artery disease (CAD) represents the leading HF etiology in HFmrEF, data about CTO in this population are rare.
METHODS
All consecutive patients with HFmrEF (ie, left ventricular ejection fraction 41%-49% with signs and/or symptoms of heart failure) undergoing invasive coronary angiography from 2016 to 2022 were included retrospectively. Patients with at least one CTO were compared to patients without CTO, further risk stratification was performed according to the extend of CAD. The primary end point was long-term all-cause mortality at 30 months (ie, median follow-up). Secondary end points comprised of major adverse cardiac and cerebrovascular events (MACCE), HF-related and cardiac rehospitalization at 30 months. Furthermore, the association of percutaneous coronary intervention (PCI) with long-term outcomes was investigated.
RESULTS
71% of patients with HFmrEF (1545/2184, primary cohort) underwent invasive coronary angiography. In patients undergoing invasive coronary angiography related to the index hospitalization, CAD was present in 81% (836/1037, final cohort), with a corresponding rate of CTO at 17% (n=141). Coronary CTO was associated with the highest rate of the primary end point (33%) compared with non-CTO (19%), single-vessel (12%) and multivessel CAD (21%) in HFmrEF (=0.001). Accordingly, HFmrEF patients with CTO had the highest rates of various secondary endpoints, including long-term MACCE compared to non-CTO patients (60% versus 32%, =0.001). Successful CTO-PCI was associated with improved long-term survival (21% versus 38%; hazard ratio, 0.49 [95% CI, 0.24-0.99]; =0.046).
CONCLUSIONS
Coronary CTO are common in HFmrEF with a significant impact on long-term prognosis.
REGISTRATION
URL: https://www.clinicaltrials.gov; unique identifier: NCT0560339.
背景
本研究调查射血分数轻度降低的心力衰竭（HFmrEF）患者中冠状动脉慢性完全闭塞（CTO）的患病率及其对预后的影响。尽管冠状动脉疾病（CAD）是HFmrEF患者心力衰竭的主要病因，但关于该人群中CTO的数据却很少。
方法
回顾性纳入2016年至2022年期间所有接受有创冠状动脉造影的连续性HFmrEF患者（即左心室射血分数为41%-49%且有心力衰竭体征和/或症状）。将至少有一处CTO的患者与无CTO的患者进行比较，并根据CAD的范围进行进一步的风险分层。主要终点是30个月时的长期全因死亡率（即中位随访期）。次要终点包括30个月时的主要不良心脑血管事件（MACCE）、与HF相关的再住院和心脏再住院。此外，还研究了经皮冠状动脉介入治疗（PCI）与长期预后的关联。
结果
71%的HFmrEF患者（1545/2184，原队列）接受了有创冠状动脉造影。在因本次住院接受有创冠状动脉造影的患者中，81%（836/1037，最终队列）存在CAD，CTO的相应发生率为17%（n = 141）。与HFmrEF中无CTO（19%）、单支血管病变（12%）和多支血管病变CAD（21%）相比，冠状动脉CTO与主要终点发生率最高（33%）相关（P = 0.001）。因此，与无CTO的患者相比，有CTO的HFmrEF患者各种次要终点的发生率最高，包括长期MACCE（分别为60%和32%，P = 0.001）。成功的CTO-PCI与改善长期生存率相关（分别为21%和38%；风险比，0.49[95%CI，0.24-0.99]；P = 0.046）。
结论
冠状动脉CTO在HFmrEF中很常见，对长期预后有重大影响。
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