Localización de la oclusión total crónica y resultados tras la intervención coronaria percutánea o el tratamiento médico: seguimiento a 10 años de un registro unicéntrico

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia Pub Date : 2025-04-05 DOI:10.1016/j.recesp.2025.01.022

Woochan Kwon , Taek Kyu Park , Ki Hong Choi , Joo Myung Lee , Jeong Hoon Yang , Young Bin Song , Joo-Yong Hahn , Hyeon-Cheol Gwon , Seung-Hyuk Choi

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Abstract

Introduction and objectives

The clinical benefits of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remain controversial. This study aimed to investigate whether PCI for CTO located in the left anterior descending artery (LAD) could have beneficial effects on clinical outcomes.

Methods

Patients were retrospectively selected from a single-center CTO registry and followed up for approximately 10 years. The patients were grouped based on the presence of LAD CTO and whether the CTO was revascularized. Inverse probability weighting adjustment was also performed. The primary outcome was the composite of cardiac death or myocardial infarction at 10 years.

Results

Among 1323 patients with CTO, 1034 were male, and 417 had LAD CTO. PCI was attempted in 72.2% of participants in the LAD CTO group and in 49.9% of those in the non-LAD CTO group. In the non-LAD CTO group, PCI did not significantly affect the primary outcome (medical therapy vs PCI, 20.7% vs 13.4%, adjusted HR: 0.72, 95%CI, 0.47–1.10; P = .13). However, a significant difference in the incidence of the primary outcome between the treatment methods was observed in the LAD CTO group (30.8% vs 15.4%; adjusted HR: 0.44; 95%CI, 0.25-0.81; P = .007). A significant interaction was observed between LAD CTO and treatment method (P for interaction = .011).

Conclusions

The benefits of PCI compared with medical therapy for CTO might be more apparent when the CTO is located in the LAD.

查看原文本刊更多论文

全慢性闭塞的位置和经皮冠状动脉干预或医疗治疗后的结果：单中心记录的10年随访

简介和目的经皮冠状动脉介入治疗慢性全闭塞（CTO）的临床益处仍存在争议。本研究旨在探讨PCI治疗位于左前降支（LAD）的CTO是否会对临床结果产生有益影响。方法回顾性地从单中心CTO登记中选择患者，随访约10年。根据LAD CTO的存在和CTO是否血运重建对患者进行分组。还进行了逆概率加权调整。主要结局是10年时心脏死亡或心肌梗死的综合结果。结果1323例CTO中，男性1034例，LAD CTO 417例。在LAD CTO组中有72.2%的参与者尝试PCI，而在非LAD CTO组中有49.9%的参与者尝试PCI。在非lad CTO组中，PCI对主要结局没有显著影响（药物治疗vs PCI， 20.7% vs 13.4%，调整后风险比：0.72,95%CI, 0.47-1.10; P = 0.13）。然而，在LAD CTO组中，两种治疗方法的主要结局发生率有显著差异（30.8% vs 15.4%；调整后危险度：0.44;95%CI, 0.25-0.81; P = 0.007）。LAD CTO与治疗方法之间存在显著的交互作用（交互作用P = 0.011）。结论当CTO位于LAD时，PCI治疗CTO的优势比药物治疗更明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista espanola de cardiologia 医学-心血管系统

CiteScore

4.20

自引率

13.60%

发文量

257

审稿时长

28 days

期刊介绍： Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.