Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
EuroIntervention. 2011 Aug;7(4):472-9. doi: 10.4244/EIJV7I4A77.
In comparison with non-occlusive lesions, percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) represents a greater challenge for the interventionalist, due to lower procedural success rates, relatively higher incidence of procedural complications and the increased rate of restenosis. The European Registry of Chronic Total Occlusion (ERCTO) was created with the goal of evaluating the real impact of CTO PCI in the European context, trying to analyse the rates of procedural success, technical information from the CTO procedures and patient outcome.
Data collection was carried out in 16 centres across Europe, starting from the beginning of January 2008. In two years of activity, a total of 1,914 patients with 1,983 CTO lesions were consecutively enrolled in the registry. Overall procedural success was achieved in 1,607 lesions (82.9%); anterograde procedures obtained higher procedural success of retrograde ones (83.2% versus 64.5%, p<0.001). Coronary perforation occurred more frequently in patients who underwent retrograde approach (4.7% versus 2.1%, p=0.04). Although no differences were observed in terms of 30-day major adverse cardiac events between anterograde and retrograde treated patients, a trend toward higher periprocedural non-Q-wave myocardial infarction was found in patients in which the retrograde approach was attempted (2.1% versus 1% p=0.08). Moreover, retrograde approach was related with longer procedural and fluoroscopy times (156.9±62.5 min vs. 98.2±52.8 min and 73.3±59.9 min vs. 38.2±43.9 min respectively, p<0.001) and higher contrast load administration (402±161 cc vs. 302±184 cc, p<0.001).
The first report of the ERCTO registry by the EuroCTO club shows a high procedural success rate obtained by expert European operators in a "real-world" consecutive series of patients, comparable with those reported by Japanese registries. The rate of observed procedural adverse events was low and similar to the non-CTO PCI series. In this registry, retrograde procedures were associated with extended fluoroscopy exposure and procedural time, increased contrast load administration as well as a higher incidence of coronary perforations. Such outcomes should become the standard of care that all centres undertaking CTO PCI should aspire to.
与非闭塞性病变相比，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）对介入医生来说是一个更大的挑战，因为其手术成功率较低，手术并发症发生率相对较高，且再狭窄率增加。创建欧洲 CTO 注册研究（ERCTO）的目的是评估 CTO PCI 在欧洲背景下的实际影响，试图分析手术成功率、CTO 手术的技术信息和患者结局。
数据收集在欧洲的 16 个中心进行，从 2008 年 1 月初开始。在两年的活动中，该注册研究共连续纳入了 1914 名患者的 1983 例 CTO 病变。1607 例（82.9%）病变获得了总体手术成功；顺行治疗的手术成功率高于逆行治疗（83.2%比 64.5%，p<0.001）。逆行治疗组发生冠状动脉穿孔的频率更高（4.7%比 2.1%，p=0.04）。虽然顺行和逆行治疗患者在 30 天主要不良心脏事件方面无差异，但尝试逆行治疗的患者围手术期非 Q 波心肌梗死发生率较高（2.1%比 1%，p=0.08）。此外，逆行治疗与更长的手术和透视时间（156.9±62.5 分钟比 98.2±52.8 分钟和 73.3±59.9 分钟比 38.2±43.9 分钟，均 p<0.001）和更高的造影剂用量（402±161 cc 比 302±184 cc，均 p<0.001）相关。
由 EuroCTO 俱乐部报告的 ERCTO 注册研究的首次报告显示，在“真实世界”连续患者系列中，经验丰富的欧洲医生获得了高手术成功率，与日本登记处报告的成功率相当。观察到的手术不良事件发生率低，与非 CTO PCI 系列相似。在该登记处中，逆行治疗与延长的透视暴露和手术时间、增加的造影剂用量以及更高的冠状动脉穿孔发生率相关。这些结果应成为所有进行 CTO PCI 的中心都应追求的标准。
