在PCI后的预测结果与不完整的再血管化:CTO和LAD船只的影响
Toshiki Kuno1,2,3, Giora Weisz4, Philippe Généreux5
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
概括
涉及左前下垂动脉 (LAD) 的穿皮冠状动脉干预 (PCI) 后的不完整复血管化 (ICR) 显示与其他冠状动脉相似的结果. 然而,慢性全闭症 (CTO) 患者的ICR导致住院和心肌梗塞的增加.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 通过皮肤冠状动脉干预 (PCI) 后的不完整的再血管化 (ICR) 与患者不良结果有关,包括死亡率和发病率.
- 了解ICR在不同冠状动脉和慢性全塞 (CTO) 的特定影响对于风险分层和治疗优化至关重要.
研究的目的:
- 为了比较ICR在左前下降动脉 (LAD) 与右冠状动脉 (RCA) 或左环动脉 (LCX) 的临床意义.
- 评估非重化慢性全闭症 (CTO) 患者的ICR是否带来了比没有CTO的患者更差的预后.
主要方法:
- 该研究分析了来自RIVER-PCI试验的数据,该试验招募了2651名PCI后ICR患者,随机分配给罗纳拉或安慰剂.
- 一个独立的核心实验室对2501名患者 (94.3%) 进行了血管学评估.
- 主要终点是由缺血驱动的再血管化或住院治疗的复合,随访时间中位数为643天.
主要成果:
- 涉及LAD的ICR发生在66.5%的患者中,而仅限于RCA或LCX的ICR发生在33.5%的患者中. 在这些组中,初级终点率相似 (26.9%对26.5%).
- 在ICR患者中有34.1%的患者中存在非再通道化的CTO. 主要终点在CTO患者中发生的频率略高 (28.6%对25.9%),尽管在统计学上不显著.
- 与没有CTO的患者相比,CTO患者的缺血驱动住院率显著更高,没有再血管 (aHR: 1.27),心力衰竭住院率 (aHR: 2.69) 和心肌梗塞 (aHR: 1.46).
结论:
- 在PCI后不完全重血管化的患者的2年预后类似,无论左前下降动脉是否参与.
- 在患有同时存在慢性全闭症的患者中,不完全的再血管化与因缺血和心肌梗塞住院的发病率较高有关.
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