Clinical Features In Patients With Coronary Chronic Total Occlusion Complicated With ACS&SAP And Risk Factors Analysis After PCI

Objective:With the development of coronary intervention technology,more and more patients with coronary chronic total occlusion(CTO)undergo percutaneous coronary intervention(PCI),a number of clinical trials also proved the benefit of CTO recanalization.However,few researches on risk factors affecting prognosis after CTO PCI has been done.For better clinical application,it’s of great value to make it clear.Methods:A total of 160 consecutive CTO patients treated in the cardiology department of China-Japan friendship hospital from January 1,2012 to May 1,2018 were retrospectively analyzed.Patients were divided into ACS group(n=124)and SAP group(n=36)according to the manifestations of stable angina pectoris(SAP)and acute coronary syndrome(ACS).After 1 year of follow-up,Clinical features,coronary angiographic features,PCI outcomes,pharmacologic treatment were compared,the observed endpoints included all-cause death,cardiogenic death,major adverse cardiovascular events(MACE),and the MACE includes three indicators:non-fatal myocardial infarction,stent thrombosis,and target vessel revascularization(TVR).Logistic regression analysis was used to find out independent risk factors associated with endpoints.Results:The proportion of patients with peripheral vascular disease in SAP group was 41.7%(15 cases),significantly higher than that in ACS group(21.8%,27cases)(P<0.017).The incidence of unstable angina(UA)and non-ST-segment elevation myocardial infarction(NSTEMI)was higher in the ACS group(61.3%(76 cases)and 30.6%(38 cases),respectively).Meanwhile,the proportion of heart failure in ACS group was 21.0%(26 cases)higher than that in SAP group(8.3%),and the number of CTO vessels was more than that in SAP group,but there was no significant differences(P>0.05).Meanwhile,no significant differences were observed in the 1-year incidence of all-cause mortality,cardiogenic mortality and major cardiac adverse events(MACE)between the two groups(P>0.05).Multivariate Logistic regression analysis showed that diuretic use[odds ratio(OR)=19.632,95%confidence interval(CI):1.497-257.392,P=0.0234]was an independent risk factor for all-cause death in 1 year.Vascular lesions with four or more vessels[OR=12.983,95%Cl:1.207～139.627,P=0.0344]were independent risk factors for cardiac death in 1 year.HbAlc level[OR=0.815,95%CI:0.675-0.983,P=0.0323],triglyceride level[OR=1.782,95%CI:1.188-2.673,P=0.0052]and CTO PCI failure[OR=9.736,95%CI:1.813-52.283,P=0.008]were independent risk factors for 1-year MACE.Triglyceride level[OR=2.891,95%CI:1.449～5.771,P=0.0026]and right coronary artery CTO(CTO-RCA)[OR=176.943,95%CI:2.796～>999.999,P=0.0052]were independent risk factors for stent thrombosis in 1 year.HDL-c[OR=78.635,95%CI:3.119～>999.999,P=0.008],number of CTO vessels[OR=3.453,95%CI;1.203～9.909,P=0.0212],branch CTO vessel(CTO-branch lesion)[OR=11.863,95%CI:1.290～109.079,P=0.0289],failure of CTO PCI[OR=12.191,95%CI:2.087-71.204,P=0.0055]were independent risk factors for 1-year TVR.Conclusion:UA and NSTEMI were more common in patients in the CTO ACS group,while peripheral vascular disease was more common in patients in the CTO SAP group.There was no significant difference in all-cause mortality,cardiogenic mortality and MACE incidence between the two groups at 1 year after PCI.Four or more multivessel lesions were independent risk factors for cardiogenic death,respectively.In addition to HbAlc,triglycerides,and HDL-c,failure of CTO PCI is an independent risk factor for 1-year MACE and TVR,while CTO-RCA is an independent risk factor for 1-year stent thrombosis,CTO-branch lesions and the number of CTO vessels is an independent risk factor for 1-year TVR.Relevant factors mentioned above should be taken into consideration,which may do some benefit to the prognosis of patients after CTO recanalization.