Early and long-term prognosis in patients with remaining chronic total occlusions after revascularization attempt. A cohort study from the SKEJ-CTO registry

The present study aimed to compare safety and long-term prognosis of patients with chronic total coronary occlusions (CTO) stratified for remaining CTOs after percutaneous coronary intervention (PCI). The study cohort consisted of patients with coronary artery disease who underwent CTO PCI in a high volume tertiary center from 2009 to 2019 and were registered in Danish high-quality registers. Patients with successful PCI of all CTOs were compared to patients with ≥1 remaining CTO post-procedural. Primary endpoints were analysed using Cox-regression and Kaplan-Meier estimates, and included all-cause mortality, major adverse cardio- and cerebrovascular events (MACCE) and a 30-day safety endpoint. Procedural success rate was 87.7%, and 76.5% of patients had all CTO(s) opened post-PCI. Safety endpoint occurred in 4.6% of patients, and more frequently in patients with remaining CTO(s) (RD 4.9, 95%CI 0.1, 9.8). All-cause mortality was higher in patients with remaining CTO(s) (Unadjusted HR 1.65, 95% CI 1.03, 2.47, p = .015. Adjusted HR 1.32, 95%CI 0.88–1.99, p = .18) after eight years of follow-up. Risk of MACCE was significantly higher in patients with remaining CTO(s) (Unadjusted HR 1.79, 95% CI 1.34–2.41, p p = .009). In our centre, CTO PCI was associated with high success rate and low risk of 30-days complications. Presence of remaining CTO(s) after final revascularization attempt was associated with higher but statistically insignificant long-term mortality but was an independent predictor of MACCE.本研究旨在对比经皮冠状动脉介入治疗（PCI）后按残留慢性完全性冠状动脉闭塞（CTO）情况分层的慢性完全性冠状动脉闭塞患者的安全性与长期预后。本研究队列纳入2009年至2019年间，在一家高流量三级医疗中心接受CTO-PCI治疗且登记于丹麦高质量注册数据库的冠状动脉疾病患者。本研究将所有CTO均经PCI成功开通的患者，与术后仍存在≥1处残留CTO的患者进行对照。主要终点采用Cox回归与Kaplan-Meier法进行分析，涵盖全因死亡率、主要不良心脑血管事件（MACCE）以及30天安全性终点。手术成功率为87.7%，76.5%的患者在PCI术后实现所有CTO的开通。4.6%的患者出现安全性终点事件，且残留CTO患者的发生率更高（风险差RD=4.9，95%置信区间CI：0.1~9.8）。经过8年随访，残留CTO患者的全因死亡率更高（未校正风险比HR=1.65，95%CI：1.03~2.47，p=0.015；校正后HR=1.32，95%CI：0.88~1.99，p=0.18）。残留CTO患者的MACCE发生风险显著更高（未校正HR=1.79，95%CI：1.34~2.41，p=0.009）。在本中心，CTO-PCI具有较高的手术成功率与较低的30天并发症风险。最终血运重建术后仍存在残留CTO，虽与长期死亡率升高相关但无统计学显著性，却是MACCE发生的独立预测因子。