Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention  

作　　者：Kong-Yong CUI Fei YUAN Hong LIU Feng XU Min ZHANG Wei WANG Ming-Duo ZHANG Yun-Lu WANG Dong-Feng ZHANG Xiao ZHANG Jin-Fan TIAN Shu-Zheng LYU 

机构地区：[1]Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University and Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing,China [2]Department of Anesthesiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing,China [3]Department of VIP Clinic,Beijing Anzhen Hospital,Capital Medical University,Beijing,China

出　　处：《Journal of Geriatric Cardiology》2020年第1期16-25,I0002-I0007,共16页老年心脏病学杂志（英文版）

基　　金：funded by the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program (No.2011BAI11B05);Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2019_014226_000023)

摘　　要：Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged reBackground In patients with acute ST-segment elevation myocardial infarction(STEMI) who undergo primary percutaneous coronary intervention(PCI), approximately 10% are concomitant with a chronic total occlusion(CTO) in a non-culprit vessel. However, the impact of staged CTO recanalization on prognosis in this cohort remains disputable. This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI. Methods Between January 2005 and December 2016, a total of 287 patients were treated with staged CTO-PCI(n=91) or medical therapy(n=196) after primary PCI in our center. The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE), defined as a composite of all-cause death, nonfatal myocardial infarction(MI), stroke or unplanned revascularization. After propensity-score matching, 77 pairs of well-balanced patients were identified. Results The mean follow-up period was 6.06 years. Overall, the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0% vs. 46.9%; hazard ratio(HR)=0.48, 95% CI: 0.29-0.77) and propensity-matched cohorts(22.1% vs. 42.9%; HR: 0.48, 95% CI: 0.27-0.86). In addition, staged CTO-PCI was also associated with reduced risk of the composite of cardiac death, nonfatal MI or stroke compared with medical therapy in both overall population(9.9% vs. 26.5%; hazard ratio(HR)=0.39, 95% CI: 0.19-0.79) and propensity-matched cohorts(9.1% vs. 22.1%; HR: 0.40, 95% CI: 0.16-0.96). After correction of the possible confounders, staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR: 0.46, 95% CI: 0.28-0.75), the composite of cardiac death, nonfatal MI or stroke(adjusted HR: 0.45, 95% CI: 0.22-0.94) and all-cause mortality(adjusted HR: 0.32, 95% CI: 0.13-0.83). Moreover, the results of sensitivity analysis were almost concordant with the overall analysis. Conclusions In patients with

关 键 词：Concurrent chronic total occlusion Long-term outcome Staged recanalization ST-segment elevation myocardial infarction 

分 类 号：R542.22[医药卫生—心血管疾病]