■慢性完全闭塞(CTO)经皮冠状动脉介入治疗(PCI)占美国稳定型心绞痛所有PCI的4%,与非-CTOPCIs相比,其成功率较低,院内事件发生率较高。我们旨在检查CTOPCI与非CTOPCI的长期结局,包括高风险非CTOPCI的预设亚组(动脉粥样硬化切除术/隐静脉移植/无保护左主干)。
■在与Medicare(2009年7月至2016年12月)相关的国家心血管数据注册CathPCI注册的551,722名患者中,我们评估了CTOPCI(N=29,407)与非CTOPCI(N=522,315)的院内事件和长期主要不良心血管事件.然后,我们评估了CTOPCI和高风险非CTOPCI之间的相似结果(N=53,662)。我们排除了ST段抬高型心肌梗死和非ST段抬高型心肌梗死的患者。
■接受CTOPCI的患者更可能是年轻和男性。与非CTOPCI(7.0%vs4.2%;P<.001)和高风险非CTOPCI(7.0%vs6.5%;P=.008)相比,CTOPCI发生院内事件的风险更高。此外,与非CTOPCI相比,CTOPCI与长期重复血运重建的风险略高相关(调整后的风险比[aHR],1.09;95%CI,1.05-1.13)。然而,与高风险的非CTOPCI相比,CTOPCI与长期主要不良心血管事件的风险略低相关(aHR,0.87;95%CI,0.84-0.90)和再入院(AHR,0.87;95%CI,0.84-0.90)。
■在这项研究中,与高风险的非CTOPCI相比,CTOPCI与院内和院外事件的风险更高相关,但长期事件的风险略低。这些发现揭示了各种PCI程序的复杂性,这些程序可以告知临床医生和患者预期的结果。
UNASSIGNED: Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) represent 4% of all PCIs for stable angina in the United States and have been associated with lower success and higher in-hospital event rates compared with non-CTO PCIs. We aimed to examine long-term outcomes of CTO PCI compared with non-CTO PCI, including prespecified subgroups of high-risk non-CTO PCI (atherectomy/saphenous vein graft/unprotected left main).
UNASSIGNED: Among 551,722 patients in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare (July 2009-December 2016), we evaluated in-hospital events and long-term major adverse cardiovascular events of CTO PCIs (N = 29,407) compared with non-CTO PCIs (N = 522,315). We then evaluated similar outcomes between CTO PCIs and high-risk non-CTO PCIs (N = 53,662). We excluded patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.
UNASSIGNED: Patients undergoing CTO PCI were more likely to be younger and male. CTO PCI was associated with a higher risk of in-hospital events compared with non-CTO PCI (7.0% vs 4.2%; P < .001) and high-risk non-CTO PCI (7.0% vs 6.5%; P = .008). In addition, CTO PCI was associated with a slightly higher risk of long-term repeat revascularization compared with non-CTO PCI (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.05-1.13). However, compared with high-risk non-CTO PCIs, CTO PCIs were associated with a slightly lower risk of long-term major adverse cardiovascular events (aHR, 0.87; 95% CI, 0.84-0.90) and readmission (aHR, 0.87; 95% CI, 0.84-0.90).
UNASSIGNED: In this study, CTO PCI was associated with higher risk of both in-hospital and out-of-hospital events but a slightly lower risk of long-term events compared with high-risk non-CTO PCIs. These findings shed light on the complexity of various PCI procedures that can inform clinicians and patients of expected outcomes.