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이승환
이승환 (Seung-Whan Lee) 저자 이메일 보기
울산대학교 의과대학, 서울아산병원
 
조회 230  인쇄하기 주소복사 트위터 공유 페이스북 공유 
Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion
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Abstract

Background:
Procedural results for percutaneous coronary intervention (PCI) in coronary vessels with chronic total occlusion (CTO) have improved in recent years, and PCI strategies have moved toward more complete revascularization with more liberal use of CTO-PCI. However, evidence evaluating CTO-PCI is limited to observational studies and small clinical trials.

Methods:
In this open-label, multicenter, randomized, noninferiority trial, PCI-eligible patients were assigned to receive either 1 of 2 strategies: PCI or no PCI for the qualifying de novo CTO lesion with the option for PCI of obstructive non-CTO lesions at the discretion of the operator. The primary end point was a composite of death, myocardial infarction, stroke, or any revascularization. Health-related quality of life was assessed at baseline and at 1, 6, 12, 24, and 36 months. Because of slow recruitment, the trial was stopped before completion of the 1284 planned enrollments.

Results:
Between March 2010 and September 2016, 834 patients were randomly assigned to the CTO-PCI (n=417) or no CTO-PCI (n=398) strategy. Among the patients assigned to the no CTO-PCI strategy, 78 (19.6%) crossed over to receive staged CTO-PCI within 3 days of randomization. The overall CTO-PCI success rate was 90.6%. Serious nonfatal complications associated with CTO-PCI occurred in 3 patients (1 stroke, 1 cardiac tamponade, and 1 patient with recurrent episodes of ventricular tachyarrhythmia induced by intracoronary thrombus). Approximately half of the patients in each group underwent PCI for an average of 1.3 non-CTO lesions, resulting in a comparable residual SYNTAX score (Synergy Between PCI With TAXUS and Cardiac Surgery; 3.7±5.4 versus 4.0±5.9, P=0.42) confined to non-CTO vessels. During a median follow-up of 4.0 years (interquartile range, 2.4 to 5.1 years), there was no significant difference between the CTO-PCI and the no CTO-PCI strategies in the incidence of the primary end point (22.3% versus 22.4%, hazard ratio, 1.03; 95% CI, 0.77 to 1.37; P=0.86). Both CTO-PCI and no CTO-PCI strategy were associated with significant improvements but without between-group differences in disease-specific health status that was sustained through 36 months.

Conclusions:
CTO-PCI was feasible with high success rates. There was no difference in the incidence of major adverse cardiovascular events with CTO-PCI versus no CTO-PCI, but the study was limited by low power for clinical end points and high crossover rates between groups.

논문정보
- 형식: Research article
- 게재일: 2019년 02월 (BRIC 등록일 2019-04-10)
- 연구진: 국내연구진태극기
- 분야: Medicine
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김원장 (울산의대, 서울아산병원)
박덕우 (울산의대, 서울아산병원)
박성욱 (울산의대, 서울아산병원)
박승정 (울산의대, 서울아산병원)
이필형 (울산대학교 의과대학, 서울...)
관련분야 논문보기
Medicine

외부링크
Google (by Seung-Whan Lee)
Pubmed (by Seung-Whan Lee)
프리미엄 Bio일정 Bio일정 프리미엄 안내
제2회 오가노이드 심포지엄 및 핸즈온워크샵 [2019 CHA Organoid Center Symposium]
제2회 오가노이드 심포지엄 및 핸즈온워크샵 [2019 CHA Organoid Center Symposium]
날짜: 2019.05.09
장소: 판교 차바이오컴플렉스 국제회의실
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