医学
经皮冠状动脉介入治疗
四分位间距
传统PCI
内科学
危险系数
置信区间
心脏病学
优势比
心肌梗塞
对数秩检验
人口
外科
比例危险模型
环境卫生
作者
Cathérine Gebhard,Aurel Toma,Min Zhao,Barbara E. Stähli,Kambis Mashayekhi,Michael Gick,Mirosław Ferenc,Heinz Joachim Büttner,Franz–Josef Neumann
出处
期刊:Thrombosis and Haemostasis
[Georg Thieme Verlag KG]
日期:2017-01-01
卷期号:117 (11): 2105-2115
被引量:7
摘要
Background As technologies of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) have improved, great uncertainty exists regarding patient selection and long-term benefit of CTO-PCI. Given that white blood cell (WBC) count has been associated with cardiovascular risk, we hypothesized that the latter might provide incremental prognostic value in patients undergoing CTO-PCI. Methods and Results Our study population consisted of 1,262 consecutive patients (76.3% males, mean age of 67.7 ± 10.3 years) who underwent elective PCI at our centre between January 2002 and December 2008. Four hundred seventy-five patients had at least one CTO, while 787 patients with non-occlusive coronary lesions served as controls. Baseline WBC count was higher in CTO patients as compared with controls (8,072 ± 3,459/μL vs. 7,469 ± 2,668/μL, p = 0.001) and independently predicted the occurrence of a CTO lesion (odds ratio: 1.8; 95% confidence interval [CI]: 1.3–2.4; p < 0.001). After a median follow-up of 3.1 years (interquartile range: 2.1–4.2 years), CTO patients with WBC counts ranging in the highest tertile had significantly worse outcomes than CTO patients with lower WBC counts (log-rank = 0.009 for all-cause mortality and log-rank = 0.01 for major adverse cardiac events). These associations were not seen in controls. Accordingly, elevated WBC count was identified as a significant predictor for all-cause mortality (adjusted hazard ratio: 3.1; 95% CI: 1.6–6.2; p = 0.001) in CTO patients but not in patients with non-occlusive coronary artery disease (p int = 0.088). Conclusion Assessment of the inflammatory status of CTO patients may be an important element in selecting CTO patients at low risk who may be referred to CTO-PCI.
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