Texas Heart Institute Journal ( IF 0.8 ) Pub Date : 2021-06-10 , DOI: 10.14503/thij-19-7023 Jah Yeon Choi 1 , Seung-Woon Rha 1 , Byoung Geol Choi 1 , Se Yeon Choi 1 , Jae Kyeong Byun 1 , Won Young Jang 1 , Woohyeun Kim 1 , Jin Oh Na 1 , Cheol Ung Choi 1 , Eung Ju Kim 1 , Chang Gyu Park 1 , Hong Seog Seo 1
We retrospectively compared the results of percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) for chronic total occlusion (CTO) in single coronary arteries to determine whether outcomes depend on the artery involved.
From January 2004 through November 2015, a total of 731 patients were treated at our center for CTO in the left anterior descending coronary artery (LAD) (234 patients, 32%), left circumflex coronary artery (LCx) (184, 25.2%), or right coronary artery (RCA) (313, 42.8%). We further classified patients by treatment (PCI or OMT) and compared the cumulative incidence of major adverse cardiac events (MACE) and the composite of total death or myocardial infarction, as well as change in left ventricular ejection fraction from baseline.
The 5-year cumulative incidence of MACE was similar between the treatment groups regardless of target vessel. The 5-year cumulative incidence of the composite of total death or myocardial infarction was significantly lower after PCI than after OMT or failed PCI in the LCx (2.6% vs 11.5%; P=0.020; log-rank) and RCA (5.8% vs 17.2%; P=0.002) groups, but not in the LAD group. Cox proportional hazards regression analysis indicated that PCI independently predicted a lower incidence of the composite of total death or myocardial infarction in the LCx group (hazard ratio [HR]=0.184; 95% CI, 0.0035–0.972; P=0.046) and the RCA group (HR=0.316; 95% CI, 0.119–0.839; P=0.021).
The artery involved does not appear to affect clinical outcomes of successful PCI for single-vessel CTO. Further investigation in a randomized clinical trial is warranted.
中文翻译：
经皮冠状动脉介入治疗单支冠状动脉慢性完全闭塞
我们回顾性比较了经皮冠状动脉介入治疗 (PCI) 和最佳药物治疗 (OMT) 治疗单个冠状动脉慢性完全闭塞 (CTO) 的结果，以确定结果是否取决于所涉及的动脉。
2004 年 1 月至 2015 年 11 月，我们中心共收治了 731 例左冠状动脉前降支（LAD）（234 例，32%）、左回旋支（LCx）（184 例，25.2%）的 CTO ，或右冠状动脉 (RCA) (313, 42.8%)。我们进一步按治疗（PCI 或 OMT）对患者进行分类，并比较了主要不良心脏事件 (MACE) 的累积发生率和总死亡或心肌梗死的复合事件，以及左心室射血分数相对于基线的变化。
无论靶血管如何，治疗组之间的 5 年累积 MACE 发生率相似。在 LCx (2.6% vs 11.5%; P = 0.020; log-rank) 和 RCA (5.8% vs 17.2%；P = 0.002) 组，但不在 LAD 组中。Cox 比例风险回归分析表明，在 LCx 组（风险比 [HR]=0.184；95% CI，0.0035–0.972；P =0.046）和 RCA组（HR=0.316；95% CI，0.119–0.839；P = 0.021）。
所涉及的动脉似乎不会影响单支血管 CTO 成功 PCI 的临床结果。有必要在随机临床试验中进行进一步研究。
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