Large Sample Single-center Study On PCI Treatment Of Single Vessel Coronary CTO

objectives:Chronic complete coronary artery occlusion is the final stage of coronary atherosclerosis.Among them,drug therapy based PCI is an important treatment for CTO at present.In the exploration period of CTO-PCI treatment,due to the lack of technology,the limitation of medical equipment,the imbalance of medical resources and other reasons,the effect of CTO-PCI treatment,the prognosis of patients,the survival rate and the re-hospitalization rate are not satisfactory.With the development of CTO special equipment and equipment,the continuous progress of PCI technology,and the further understanding of the indications of interventional therapy for CTO lesions,relevant interventional therapy strategies and clinical benefit studies,the success rate of CTO-PCI has been significantly improved.However,the benefits of interventional therapy for CTO lesions of different single-vessel coronary arteries are rarely studied and still controversial.This study retrospectively analyzed the difference of survival benefit between patients receiving interventional opening therapy + optimal drug therapy and patients receiving only optimal drug therapy for CTO lesions of different single-vessel coronary arteries,and further analyzed the main risk factors affecting the occurrence of MACE events in CTO patients based on data statistics.To provide objective clinical basis for rational selection of treatment and improvement of clinical prognosis of patients with CTO in different target vessels.Methods:A total of 774 patients with single-vessel CTO who were admitted to the Department of Cardiology and underwent coronary angiography in our hospital from January 2017 to December 2019 and met the inclusion and exclusion criteria were enrolled.Basic information of each patient was obtained from outpatient and inpatient electronic medical record systems,and baseline data,such as general personal clinical information,laboratory tests,cardiac ultrasound results,interventional procedures and specific conditions,were collected before enrolment.All CTO patients were followed up for at least 12 months for major adverse cardiovascular events including angina pectoris,readmission with exacerbation of heart failure,non-fatal myocardial infarction,and cardiogenic death during the one-year period.Target according to the results of coronary angiography and PCI patency of the CTO patients divided into CTO-PCI group(on the basis of the best drug treatment)and OMT(best)drug treatment group(including tentative PCI)in patients with failure,according to according to the results of coronary angiography in the CTO target divided into anterior descending branch of patency group(LAD-PCI)and drug treatment group(LAD-OMT),wiggle the open group(LCX-PCI)and drug treatment group(LCX-OMT),right coronary artery open group(RCA-PCI)and drug treatment group(RCA-OMT),The incidence of major adverse cardiovascular events in the control group was compared according to the statistical results.SPSS26.0 statistical software was used for data analysis.Measurement data conforming to normal distribution were expressed as mean ± standard deviation,and t test was used for comparison between groups.The measurement data that did not conform to the normal distribution were represented by median and interquaternary interval,and the comparison between groups was performed by rank sum test.Enumerative data were presented as frequency or percentage,and comparison between groups was performed by the chi-square test or Fisher’s exact probability method.Survival analysis was performed by Kaplan-Meier method,and significance test was performed by Log-rank method.Cox regression was used to analyze the risk factors for outcome events,and univariate P <0.05 was included in the multivariate model.When the difference between the groups was statistically significant,a pairwise comparison was made after the event.Graph Pad Prism software was used for drawing.In all the above results,P < 0.05 was considered statistically significant.Results:1.Among the 377 patients with single-vessel CTO,631 patients(81.52%)were in the CTO-PCI group and 143 patients(18.48%)were in the CTO-OMT group.Subgroups were divided according to the location of CTO lesions: 259 cases(33.46%)in the LLA-PCI group,91 cases(11.76%)in the LCX-PCI group,281 cases(36.60%)in the RCA-PCI group,38 cases(4.91%)in the LLA-OMT group,26 cases(3.36%)in the LCX-OMT group,and 79 cases(10.21%)in the RCA-OMT group.The basic information is shown in the figure..2.All 744 patients with single CTO MACEs events occurring in 182 patients(24.46%)of the communist party of China,the central source sex death PCI group 16cases(2.54%),OMT,9 cases(6.30%),nonfatal myocardial infarction PCI group in 2cases(0.32%),OMT,2 cases(1.40%),target vessels reascularization PCI group and 8cases(1.27%),OMT set of 17 cases(11.89%),angina or heart failure and hospitalization PCI group 99 cases(15.69%),OMT,29 cases(20.28%).The differences were statistically significant(P < 0.05).In the LAD group,the number of total MACE events in the PCI group was higher than that in the OMT group [56(21.62%)vs.16(42.10%),P < 0.01].In the LCX group,the number of total MACE events in PCI group was higher than that in OMT group [17(18.68%)vs.11(42.31%),P=0.013].In the RCA group,the number of total MACE events in the PCI group was higher than that in the OMT group [52(18.51%)vs.30(37.97%),P < 0.01].3.Kaplan-Meier survival analysis and Log-rank test were used to draw the1-year survival curve of patients after discharge.The analysis results showed that there were significant differences in the prognostic survival curves between the PCI group and the OMT group for all patients enrolled in this study,P <0.01.The PCI of single CTO patients was significantly different from that of OMT1 in MACE events.In the LAD,LCX and RCA subgroups,there were significant differences in the prognostic survival curves between the PCI group and the OMT group,P <0.01.4.Cox multivariate analysis results of prognostic MACE events in all single-vessel CTO patients: NYHA grade III-IV,urea nitrogen and anemia were independent risk factors for MACE events in CTO patients,and PCI in CTO vessels was independent protective factors for MACE events in CTO patients.In the LAD group,NYHA grade III-IV was an independent prognostic risk factor for MACE events in anterior descending branch CTO patients.In LCX group,hs-CRP was an independent risk factor for the prognosis of CTO patients with MACE events,while glutamic-oxalate transaminase,oral β-blocker,and CTO vascular PCI were independent protective factors for the prognosis of CTO patients with MACE events.In the RCA group,higher than normal urea nitrogen level,anemia,white blood cell count,and BMI were independent risk factors for MACE events in right coronary CTO patients,and HDL-C was an independent protective factor for MACE events in right coronary CTO patients.5.Logistic regression analysis of all single CTO vessels showed that age ≤65years old,CCSI-II grade,NYHA I-II grade and BMI≤24KG/M2 were independent predictors of CTO vessel opening.Multiple Logistic regression analysis of LAD single CTO vessel showed that CCSI-II grade,NYHA grade,creatinine level and BMI were independent predictors of anterior descending CTO vessel opening.LCX single-vessel CTO multivariate Logistic regression analysis showed that BMI was an independent predictor of whether patients’ circumflex CTO vessels were open or not.Multiple Logistic regression analysis of RCA single-vessel CTO vessels showed that CCS grade,EF value ≥50%,creatine kinase and BMI≤24KG/M2 were independent predictors of CTO vessel openage in patients with RCA.6.In the CTO population,patients with dialysis and NYHA grade III-IV are the high risk factors leading to the occurrence of long-term MACE,and the prognostic survival curve of patients with the above high risk factors after PCI treatment is significantly different from that of patients receiving OMT treatment alone,P <0.01.Conclusion:1.In this study,PCI opening treatment for all single-vessel coronary CTO lesions can significantly reduce the occurrence of long-term MACES events and improve the prognosis of patients with CTO lesions compared with patients who only received optimal drug therapy.The CTO lesions of LAD,LCX and RCA vessels are all suitable for the above conclusions.This conclusion may help to optimize treatment options for different coronary CTO lesions.2.In this study,for all single-vessel CTO disordered vessels,NYHA grade III-IV,urea nitrogen level and the presence of anemia were independent risk factors affecting the prognosis of MACE events in CTO patients,and PCI treatment of CTO vessels was an independent protective factor for the prognosis of MACE events in CTO patients.This conclusion has certain reference significance in the clinical intervention of prognosis of CTO patients.3.In this study,age ≤65 years old,CCSI-II,NYHA I-II,and BMI≤24KG/M2 were independent predictors of CTO vascular opening in all single-vessel CTO lesions.This conclusion can be used for reference when choosing the treatment plan of CTO patients in clinic.4.In this study,in all single-vessel CTO diseased vessels,associated dialysis and NYHA cardiac function grade III-IV are high risk factors for the occurrence of long-term MACE events,and more attention should be paid to the long-term prognosis of these two types of CTO patients in the clinic.