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Abstract：
Background Fifteen percent of patients with coronary artery disease undergoing angiography have a chronic total occlusion (CTO). The current study aimed to investigate the long-term prognosis after successful and unsuccessful CTO percutaneous coronary intervention (PCI) compared with PCI for non-CTO lesions. Methods and Results The current study was designed as an observational, region-wide, register-based cohort study enrolling all patients undergoing PCI in the Central Region of Denmark in 2009 to 2019. Patients were stratified into non-CTO, successful CTO, and unsuccessful CTO revascularization. Patients were followed until an event or January 1, 2022. The primary end point was all-cause mortality. In 21 141 patients enrolled, 2108 underwent CTO PCI. Clinical presentation was acute coronary syndrome in 11 879 patients and chronic coronary syndrome in 7887 patients. After a median of 5.7 years (interquartile range, 3.3-8.8), long-term all-cause mortality was higher after CTO PCI compared with non-CTO PCI, but the difference was statistically insignificant when adjusting for clinical factors (unadjusted hazard ratio [HR], 1.19 [95% CI, 1.09-1.29], adjusted HR, 1.08 [95% CI, 0.97-1.20]; P=0.165). After successful CTO PCI, no difference compared with non-CTO PCI was observed (unadjusted HR, 0.99 [95% CI, 0.90-1.10], adjusted HR, 0.99 [95% CI, 0.87-1.12]; P=0.873). After unsuccessful CTO PCI, long-term all-cause mortality was higher than non-CTO PCI (unadjusted HR, 1.82 [95% CI, 1.59-2.08], adjusted HR, 1.35 [95% CI, 1.13-1.63]; P<0.001). Conclusions Patients undergoing PCI for CTO have elevated long-term mortality compared with patients without CTO. Successful opening of the CTO(s) is associated with equal mortality compared with non-CTO PCI. In contrast, failed CTO PCI is associated with worse long-term mortality. These findings suggest the need for CTO programs with high success rates and low complication rates.
摘要：
背景：15%的冠状动脉疾病患者接受血管造影术有慢性完全闭塞（CTO）。本研究旨在探讨成功和不成功的CTO经皮冠状动脉介入治疗（PCI）与PCI治疗非CTO病变后的长期预后。方法和结果本研究被设计为观察性的，全区域,基于注册的队列研究纳入2009年至2019年丹麦中部地区所有接受PCI的患者.患者被分层为非CTO，成功的CTO,和失败的CTO血运重建。对患者进行随访，直到事件发生或2022年1月1日。主要终点是全因死亡率。在21141名患者中，2108接受CTOPCI。临床表现为急性冠脉综合征11879例，慢性冠脉综合征7887例。经过5.7年的中位数（四分位数间距，3.3-8.8),CTOPCI术后的长期全因死亡率高于非CTOPCI，但在调整临床因素时差异无统计学意义(未调整的风险比[HR],1.19[95%CI，1.09-1.29]，调整后的HR，1.08[95%CI，0.97-1.20]；P=0.165）。CTOPCI成功后，与非CTOPCI相比，没有观察到差异（未调整的HR，0.99[95%CI，0.90-1.10]，调整后的HR，0.99[95%CI，0.87-1.12]；P=0.873）。CTOPCI不成功后，长期全因死亡率高于非CTOPCI（未调整的HR，1.82[95%CI，1.59-2.08]，调整后的HR，1.35[95%CI，1.13-1.63]；P<0.001）。结论接受CTOPCI的患者与未接受CTO的患者相比，长期死亡率升高。与非CTOPCI相比，成功开放CTO与同等死亡率相关。相比之下,CTOPCI失败与更差的长期死亡率相关.这些发现表明需要具有高成功率和低并发症发生率的CTO计划。
