冠状动脉慢性完全闭塞病变介入治疗成功与否对患者预后影响的研究

Long-term Clinical Outcomes Comparison Between Coronary Chronic Total Occlusion Patients With Successful Versus Non-successful Percutaneous Coronary Interventions

目的:探讨冠状动脉慢性完全闭塞病变(CTO)介入治疗成功与否对患者预后的影响。方法:纳入2013年1月至2013年12月于中国医学科学院阜外医院行介入治疗的CTO患者1 363例。根据介入治疗是否成功分为两组:成功组(n=1 090)和失败组(n=273)。比较两组患者临床及造影情况,多因素Cox生存分析比较两组随访期间发生的主要不良心血管事件(MACE),包括全因死亡、心肌梗死和再次血运重建。结果:与成功组相比,失败组吸烟(68.1%vs 60.6%, P=0.023)及既往PCI患者(28.2%vs 22.2%,P=0.036)比例更高,失败组右冠状动脉CTO更常见(57.1%vs 44.0%,P=0.000),迂曲病变(70.7%vs 60.9%,P=0.003)和中、重度钙化病变(30.0%vs 21.2%,P=0.002)的比例更高。在平均29个月的随访期间内,成功组MACE(14.6%vs 23.1%,P=0.000)和再次血运重建(12.0%vs 22.3%,P=0.000)的发生率明显低于失败组,而全因死亡(2.3%vs 0.7%,P=0.112)和心肌梗死(1.3%vs 1.1%,P=0.796)的发生率在两组之间差异无统计学意义。多因素Cox分析显示,在排除其他影响因素的情况下,CTO介入治疗成功仍然可以减少术后的MACE风险(HR=0.661,95%CI:0.488~0.894,P=0.007)。当靶病变为左前降支或右冠状动脉时,成功组MACE事件显著减少;当靶病变为左回旋支时,成功组和失败组的MACE事件发生率相当。结论:成功的冠状动脉CTO介入治疗可以减少患者远期MACE事件的发生率。其主要减少了患者再次血运重建的需要,而在全因死亡和心肌梗死方面,成功组和失败组之间差异无统计学意义。

Objectives: The purpose of this study was to evaluate long-term clinical outcomes after successful versus failed percutaneous coronary intervention for chronic total occlusion(CTO).Methods: A total of 1 363 consecutive patients with CTO lesions undergoing PCI in Beijing Fuwai Hospital from January 2013 to December 2013 were enrolled. They were divided into two groups: success PCI group(n=1 090) and failure PCI group(n=273). The major adverse cardiovascular events(MACE), all-cause death, myocardial infarction(MI) and target vessel revascularization(TVR) during follow-up were compered between the two groups.Results: Percent of smokers(68.1% vs 60.6%), PCI history(28.2% vs 22.2%), RCA(57.1% vs 44.0%)CTO lesions, tortuous(70.7% vs 60.9%) and calcification lesions(30.0% vs 21.2%) was significantly higher in the failure PCI group than in success PCI group(all P<0.05). At a median follow-up of 29 months, MACE(14.6% vs 23.1%,P=0.000) and TVR(12.0% vs 22.3%,P=0.000) events were significantly lower in success PCI group than in failure PCI group. However, the risk of death or myocardial infarction were similar between the two groups. Cox regression analysis demonstrated that successful CTO-PCI was independently associated with a lower risk of MACE(adjusted HR=0.661;95%CI: 0.488–0.894;P=0.007). In subgroup analysis, the success of LAD or RCA CTO-PCI reduced MACE events, while the incidence of MACE in the LCX CTO subgroup was comparable between the success and failure PCI groups.Conclusions: Successful CTO-PCI is associated with significantly lower MACE rate, less subsequent revascularization compared to failure PCI group. However, the risk of death or myocardial infarction are similar between the success and failure PCI groups.