| Background and aim: There is still controversy on how to choose a treatment strategy for coronary chronic total occlusion(CTO)patients with multivessel coronary lesions.The purpose of this study is to compare the prognostic effects of different treatment strategies on CTO patients with multiple coronary lesions,and provide a certain theoretical basis for the selection of treatment strategies for such patients.Method: A total of 11,007 patients who were admitted to the Department of Cardiology in the First Affiliated Hospital of Dalian Medical University and underwent coronary angiography from January 01,2016 to December 31,2018 were continuously collected through the Lianzhong Medical Record System.Only 9,446 patients with primary angiography were collected.There were 1,099 chronic coronary total occlusion patients with multivessel coronary lesions,and 608 patients eligible for enrollment.The baseline characteristics and treatment strategies were recorded and analyzed in the study population.All patients were followed up(median time 21 months).The primary study endpoint was the incidence of major cardiac adverse events including all-cause death,unstable angina,acute myocardial infarction,revascularization,and heart failure.530 patients completed follow-up and were grouped according to different treatment strategies: 86 cases in the optimal medical treatment(OMT)group,416 cases in percutaneous coronary intervention(PCI)group and 28 cases in the coronary artery bypass grafting(CABG)group.The PCI group was devided into PCI only in thenon-CTO group 271 cases and PCI complete revascularization group 145 cases.The incidence of endpoint events was compared between the four groups,and the factors affecting the prognosis were analyzed.Results:1.Among all patients who received primary coronary angiography,the detection rate of CTO patients was 13.7%(1291/9446),and the detection rate of CTO patients with multiple coronary lesions was 11.6%(1099/9446).The median age of the study was 64(58,70)years old.Most of them were male(79.6%),complicated with hyperlipidemia(85.3%)and hypertension(72.1%).Most patients were performed by percutaneous coronary intervention(78.5%),followed by medication(16.2%)and coronary artery bypass grafting(5.3%).2.Chronic coronary total occlusion often involved the right coronary artery(40.4%),followed by left circumflex(32.8%)and left anterior descending branch(26.8%).Most of the lesions were located in the near-middle section of the coronary arteries(69.4%),and existed collateral circulation(53%).3.There was significant difference in the incidence of unstable angina pectoris(24.4% vs 17.7% vs 10.3% vs 7.1%,P = 0.018)and heart failure(4.7% vs 3.0% vs2.8% vs 14.3%,P = 0.022)among the four groups.Subgroup analysis showed that the long-term survival rate of CTO patients treated with PCI complete revascularization and PCI only in non-CTO vessels were significantly higher than those in OMT group(100% vs 98.5% vs 94.2%,log-rank test P <0.05).The incidence of unstable angina pectoris in the OMT group was obviously higher than that in both PCI only in non-CTO vessel and complete revascularization group(P <0.05).The subgroup analysis of patients with complete revascularization found that the incidence of heart failure in the CABG group was significantly higher than that in the PCI complete revascularization group(14.3% vs 2.8%,P = 0.030),but there was no statistically difference in the incidence of unstable angina pectoris and revascularization(both P>0.05)between the two groups.4.Increased creatinine and complete revascularization by PCI are the twoindependent risk factors for endpoint events in the study population.Conclusion: Chronic coronary total occlusion patients with multivessel lesions have a lower incidence of long-term cardiac adverse events after PCI.Complete revascularization strategy is better than partial revascularization strategy for CTO patients with multivessel lesions. |
PDF Full Text Request