Long-Term Outcomes of Successful Recanalization Compared With Optimal Medical Therapy for Coronary Chronic Total Occlusions in Patients With and Without Left Ventricular Systolic Dysfunction
| Autor: | Huaiyu Ding, Shaoke Meng, Lei Zhong, Haichen Lv, Xiaoyan Zhang, Lei Guo, Jiaying Xu, Jian Wu, Rongchong Huang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
LVEF medicine.medical_treatment 030204 cardiovascular system & hematology Cardiovascular Medicine outcomes 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Diseases of the circulatory (Cardiovascular) system 030212 general & internal medicine cardiovascular diseases Original Research Ejection fraction business.industry Incidence (epidemiology) Confounding percutaneous coronary intervention Percutaneous coronary intervention Retrospective cohort study optimal medical therapy RC666-701 chronic total occlusions Conventional PCI Propensity score matching Cardiology business Cardiology and Cardiovascular Medicine Mace left ventricular systolic dysfunction |
| Zdroj: | Frontiers in Cardiovascular Medicine Frontiers in Cardiovascular Medicine, Vol 8 (2021) |
| ISSN: | 2297-055X |
| Popis: | Background: The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs. optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function.Methods: A total of 1,895 patients with CTOs were stratified according to LV function. Of these, 1,420 patients (74.9%) with LV ejection fraction (LVEF) >45% and 475 patients (25.1%) with LVEF ≤45% were treated with optimal MT or successful CTO percutaneous coronary intervention (PCI). A 1:1 propensity score matching (PSM) was conducted to reduce the impact of potential confounding on the outcomes. The primary outcome was the frequency of major adverse cardiac events (MACEs).Results: Throughout a 2.6-year follow-up and after adjusting for confounders, among patients with preserved LV function, successful CTO PCI was associated with reduced incidence of MACE (14.2 vs. 23.9%, adjusted HR 0.63, 95% CI 0.48–0.83, p = 0.001) compared to MT. There was no significant difference in MACE occurrence (29.6 vs. 28.9%, adjusted HR 1.05, 95% CI: 0.71–1.56, p = 0.792) between successful recanalization and MT in patients with LV systolic dysfunction. The primary outcome among patients with impaired and preserved LV systolic function after PSM was similar to that from earlier findings before PSM was conducted. A significant interaction between LV function and therapeutic strategy for MACE was observed (interaction p = 0.038).Conclusions: Compared to MT alone for management of patients with CTOs, successful CTO PCI may reduce the risk of MACE in patients with preserved LV systolic function, but not in patients with LV dysfunction. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|