Impact of Coronary Chronic Total Occlusion on Long-term Clinical Outcome in Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention

I. Sheiban, Filippo Figini, Valeria Gaspartto, C. Moretti, F. Leonardo, Shaoliang Chen, F. D’Ascenzo
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引用次数: 1

Abstract

Objectives: Reported data regarding the prevalence, prognostic impact, and safety and efficacy of revascularization of coronary chronic total occlusion (CTO) in patients with left main coronary artery (LMCA) disease who undergo percutaneous coronary intervention (PCI) are scarce. The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI. Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures. Methods: All consecutive patients with significant LMCA disease (>50% stenosis at coronary angiography) who underwent PCI between July 2014 and December 2018 were retrospectively included in our study. The primary endpoint of the study was long-term mortality. Secondary endpoints included the incidence of myocardial infarction, repeat percutaneous or surgical revascularization, stroke, and stent thrombosis. Results: Between July 2014 and December 2018, 578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled. They were divided into 3 groups: group A: 374 (65%) patients without CTO, group B: 108 (19%) patients with untreated or unsuccessfully treated CTO, and group C: 96 (17%) patients with successfully treated CTO. At a median follow-up of (1090 ± 279) days, there were no statistically significant differences between the groups in terms of the primary and secondary endpoints. However, there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO (13% vs. 19% vs. 14% in groups A, B, and C, respectively; P = 0.12). The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability: subgroup C1: 54 (56%) patients with successful percutaneous transluminal coronary angioplasty (PTCA) having viability, and subgroup C2: 42 (44%) patients with successful PTCA not having viability. There was a trend toward a statistically significant higher rate of death among patients in group B, who underwent unsuccessful recanalization with viable myocardium (19% vs. 9% vs. 19% in groups B, C1, and C2, respectively, P = 0.05). On multivariable analysis, the propensity for successful revascularization of CTO was associated with a reduced risk of death (P = 0.01; odds ratio, 0.75; 95% confidence interval: 0.62–0.87). Conclusions: Among patients with LMCA disease undergoing PCI, CTO represents a common finding associated with worse prognosis. Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.
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冠状动脉慢性完全闭塞对经皮冠状动脉介入治疗无保护左主干病变患者长期临床结果的影响
目的:关于接受经皮冠状动脉介入治疗(PCI)的左主干冠状动脉(LMCA)患者冠状动脉慢性完全闭塞(CTO)血运重建的患病率、预后影响、安全性和有效性的报道数据很少。本研究的目的是比较接受PCI的LMCA疾病患者的临床结果。比较有和没有冠状动脉CTO的患者以及有CTO的成功和不成功的CTO再通手术的患者的结果。方法:回顾性纳入2014年7月至2018年12月期间接受PCI治疗的所有患有严重LMCA疾病(冠状动脉造影狭窄>50%)的连续患者。该研究的主要终点是长期死亡率。次要终点包括心肌梗死、重复经皮或手术血运重建、中风和支架血栓形成的发生率。结果:2014年7月至2018年12月,在Pederzoli医院和都灵大学,578名患者因LMCA疾病接受了PCI治疗。他们被分为3组:A组:374名(65%)无CTO的患者,B组:108名(19%)CTO未治疗或治疗失败的患者,C组:96名(17%)CTO治疗成功的患者。中位随访(1090 ± 279)天,两组之间在主要终点和次要终点方面没有统计学上的显著差异。然而CTO未治疗或治疗失败的患者死亡率有上升趋势(a、B和C组分别为13%、19%和14%;P=0.012)。根据心肌活力的存在与否,进一步分析主要和次要终点:C1亚组:54(56%)成功经皮冠状动脉腔内成形术(PTCA)的患者C2亚组:42例(44%)成功PTCA患者没有生存能力。B组患者的死亡率有统计学意义上更高的趋势,这些患者接受了存活心肌再通失败(B组、C1组和C2组分别为19%对9%对19%,P=0.05)。在多变量分析中,CTO成功血运重建的倾向与死亡风险的降低有关(P=0.01;比值比0.75;95%置信区间:0.62-0.87)。结论:在接受PCI的LMCA疾病患者中,CTO是一种常见的预后较差的发现。在有存活心肌的患者中成功进行CTO血运重建似乎可以显著改善预后。
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