The Clinical Outcomes Of Patients With Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention

Part Ⅰ:Safety and Long-term Clinical Effects of Percutaneous Coronary Intervention on Coronary Chronic Total Occlusion Among Patients With Left Ventricular Ejection Fraction ≤50%Objectives:To evaluate the safety and long-term(5-years)clinical effects of percutaneous coronary intervention(PCI)on chronic total occlusion(CTO)lesions among left ventricular ejection fraction(LVEF)≤50%patients.Metheds:Retrospect the clinical datum of a total of 303 patients with LVEF≤50%(LVEF≤50%group)who underwent CTO interventional therapy in ^hospital from January 2010 to December 2013.By propensity score matching(1:1),another 303 cases with LVEF>50%was included(LVEF>50%group).The clinical datum were followed up to 5th years after PCI.The primary composite endpoint defined as cardiac death or target vessel related MI or target vessel revascularization(TVR).Secondary endpoint defined as:success rate,complication,death,cardiac death,target vessel related myocardial infarction(TV-MI),target vessel related revascularization(TVR),heart failure for rehospitalization.Results:The SYNTAX scores was significant higher in LVEF≤50%group(19.27±9.03 vs.17.09±9.22,P=0.003).The rate of success PCI(71.9%vs.74.3%,P=0.52)and complication(35.0%vs.34.3%,P=0.86)had no significant difference.548 cases(90.4%)were followed up to 5 years.The primary endpoint rate at 5 years was significant higher in LVEF≤50%group(18.5%vs.12.5%,P<0.001),which driven by TVR(12.9%vs.7.9%,P=0.046).There were no significant difference of other secondary endpoints(cardiac death,TV-MI,heart failure for rehospitalization,Pall>0.05)between two groups.The logistic regression analysis of the primary endpoints was shown that longterm medication of clopidogrel decrease these risks。Conclusion:Patients with LVEF≤50%underwent CTO-PCI has similar short-term safety and efficacy with LVEF>50%cases.But they had more long－term risks mainly driven from TVR and clopidogrel could decreased those risks.Part Ⅱ:5-Year Clinical Outcomes Of Patients With InStent Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention:A Single-Center Corhort Study Compared With Denovo Chronic Total OcclusionObjectives To evaluate the safety and long-term clinical efficacy of percutaneous coronary intervention(PCI)in patients with in-stent chronic total occlusion(IS-CTO)lesions.Metheds This is a retrospective analysis.Patients with IS-CTO who underwent PCI in ^ hospital from January 2010 to December 2013 were enrolled.A total of 212 patients who met the inclusion criteria were included in the IS-CTO group,212 matched patients with primary CTO lesions were included in the de novo CTO group.The incidence of complications and the success rate of PCI were compared between the two groups.Successful PCI was defined as successfully implantation of stent(s)at target CTO lesions.The primary endpoint was defined as a composite event of cardiac death and myocardial infarction(MI).Secondary endpoints including PCI success,allcause death,cardiac death,MI,target vessel related MI,revascularization,target vessel revascularization,heart failure for rehospitalization.The patients were followed up for 5 years after PCI.Results A total of 424 cases were included.The mean age was(57.8±10.5)years,there were 364 males in this cohort.The left ventricular ejection fraction was significantly lower((58.7±9.2)%vs.(61.0±7.7)%,P=0.01)and the SYNTAX scores was significantly higher(19.4±8.3 vs.15.31±10.0,P<0.01)in IS-CTO group than in de novo CTO group.The proportion of patients with target CTO lesions in left anterior descending artery was significantly higher(42.9%(50/212)vs.23.6%(91/212),P<0.01)in IS-CTO group than in de novo CTO group.The rate of successful PCI(71.7%(152/212)vs.69.8%(148/212),P=0.70)and complication(40.6%(86/212)vs.36.3%(77/212),P=0.37)was similar between the two groups.The incidence of primary endpoint at 5 years was significantly higher in IS-CTO group(10.8%(23/212)vs.4.7%(10/212),P=0.02),which was driven by higher incidence of MI(9.0%(19/212)vs.4.2%(9/212),P=0.05).There were a trend of higher secondary endpoints in IS-CTO group(all P>0.05).Conclusion The safety and effectiveness of PCI are acceptable in patients with IS-CTO,but the risk of long-term cardiac death and MI is higher among patients with IS-CTO as compared to patients with primary CTO lesions.Part Ⅲ:Long Term Clinical Outcomes Of Patients With InStent Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention:Compared With Medicine TherapyObjectives Retrospect the success rate and compare the long-term clinical efficacy of percutaneous coronary intervention(PCI)in patients with instent chronic total occlusion(IS-CTO)lesions with whom accepted medicin therapy after PCI failed.Metheds This is a retrospective analysis.Patients with IS-CTO underwent PCI and met the inclusion criteria in ^ hospital from January 2010 to December 2013 were enrolled.Grouped by whether IS-CTO PCI success or not,152 cases divided into success group and 60 cases in medicin therapy after failed PCI(MT).The incidence of complications and the success rate of PCI were noted.Successful PCI defined as successfully implantation of stent(s)at target IS-CTO lesions.The primary endpoint defined as a composite event of cardiac death,myocardial infarction(MI)and target vessel revascularization(TVR).Secondary endpoints including perioperative myocardial infarction,allcause death,cardiac death,MI,target vessel related MI,revascularization,TVR,target lesion rehospitalization(TLR).The patients were followed up for 5 years after PCI.Results A total of 212 cases were included.The mean age was(57.6±10.8)years,180 males in this study.The rate of successful PCI was 71.7%(152/212)and complication(40.6%(86/212).Compareted with MT group,the proportion of patients with target CTO lesions in left anterior descending artery was significantly higher(48.1%(74/152)vs.28.2%(17/60),P=0.01)in success group.The rate of complication(25.0%(38/152)vs.80.0%(48/60),P<0.01)was lower in success groups.The incidence of primary endpoint at 5 years was lower in success group(19.1%(29/152)vs.25.0%(15/60),P=0.34)without significant difference.There were a lower trend of secondary endpoints in success group(all P>0.05).Conclusion There were a lower trend of long-term cardiac death,MI and TVR in patients with IS-CTO underwent PCI.