TCT2017:研究荟萃:ESRD患者 & STEMI患者CTO血运重建的结局

2017-11-04 佚名 国际循环

介入技术的不断改进,冠状动脉慢性完全闭塞(CTO)病变的PCI成功率取得了明显提高,但CTO患者血运重建的临床结局怎样?TCT 2017大会上,美国哥伦比亚大学Yasir Parviz教授和荷兰阿姆斯特丹大学Joelle Elias教授报告了两项最新研究结果。

介入技术的不断改进,冠状动脉慢性完全闭塞(CTO)病变的PCI成功率取得了明显提高,但CTO患者血运重建的临床结局怎样?TCT 2017大会上,美国哥伦比亚大学Yasir Parviz教授和荷兰阿姆斯特丹大学Joelle Elias教授报告了两项最新研究结果。

1. ESRD患者CTO血运重建的可行性、安全性及结局

目前,尚不清楚终末期肾脏疾病(ESRD)患者CTO血运重建的可行性、安全性及结局。美国哥伦比亚大学的Yasir Parviz教授等就此问题进行了探讨(摘要号:TCT18)

该研究对行CTO血运重建并接受了长达1年随访的伴有ESRD的40例患者和不伴有ESRD的87例患者进行回顾性对比分析。结果发现,与不伴有ESRD者相比,伴有ESRD者风险更高,女性比例更高(27% vs. 10%,P=0.01),较多伴有糖尿病(97% vs. 27%,P<0.0001)、吸烟史(65% vs. 43%,P=0.004)、心肌梗死(57% vs. 31%,P=0.006)、外周动脉疾病(65% vs. 9.3%,P<0.0001)及充血性心力衰竭(43% vs. 23%,P=0.03),射血分数减低[(43±14) vs.(51±13),P=0.004)],J-CTO评分相似[(1.9±0.6)vs.(2.0±1.2),P=0.44)。进一步分析显示,与不伴有ESRD者相比,伴有ESRD者的CTO-PCI成功率相似(83% vs. 86%,P=0.79),1年临床终点发生情况见下表。具体来说,两组患者CTO-PCI后心绞痛症状均显着减轻。但是,与不伴有ESRD者相比,伴有ESRD者CTO-PCI后主要终点[死亡、心肌梗死、靶血管血运重建(TVR)的复合终点]风险更高(HR=4.0,95%CI:1.6~10.3,P=0.003),主要终点各组分即死亡、心肌梗死及TVR的风险均显着增加[相对应的HR值分别为5.2(95%CI:1.3~21.0,P=0.01)、10.7(95%CI:2.0~95.6,P=0.03)和4.0(95%CI:0.9~16.6,P=0.05)],CHF再住院风险无差异。



上述结果提示,ESRD患者行CTO PCI具有较高的技术成功率,可显着改善心绞痛症状,但晚期不良事件发生率较常见,这主要与这类患者的基线风险显着增加有关。

2. 急性STEMI患者直接PCI时行CTO血运重建的全球随机前瞻性多中心研究

关于伴有CTO拟行直接PCI的STEMI患者,CTO血运重建进行与否对其长期结局的影响尚不清楚。荷兰阿姆斯特丹大学的Joelle Elias等开展的EXPLORE研究就此问题进行了探讨(摘要号:TCT 19)。

研究共计入选2007年10月~2015年4月302例伴有CTO的STEMI患者,将其随机分为CTO血运重建组(n=148)和CTO未血运重建组(n=154),于术后1年、2年、3年、4年及5年进行临床随访,于术后1年行心脏核磁共振成像(CMR)检查。两组患者的平均年龄均为(60±12)岁,基线特征无差异。所有患者均完成了1年临床随访,平均长期随访时间为(3.1±1.5)年。研究的主要终点为随访5年内主要不良心脏事件(心源性死亡、冠状动脉旁路移植、心肌梗死的复合终点)。

EXPLORE研究是评估CTO血运重建对STEMI患者PCI结局影响的首项随机临床试验,其随访4个月时主要终点(左心室射血分数及左心室舒张末期容积)均未达预设终点。本届TCT大会上,研究者发布了该研究的中长期临床结局及1年CMR结果。



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    2018-04-24 gao_jian4217
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    2018-03-03 zhaojie88
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    2017-11-06 yige2004
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