冠状动脉慢性完全闭塞介入治疗中分支血管闭塞的预测因素与结局

Predictors and Outcomes of Side-Branch Occlusion in Coronary Chronic Total Occlusion Interventions.

作者信息

Nguyen-Trong Phuong-Khanh J, Rangan Bavana V, Karatasakis Aris, Danek Barbara A, Christakopoulos Georgios E, Martinez-Parachini Jose Roberto, Resendes Erica, Ayers Colby R, Luna Michael, Abdullah Shuaib, Kumbhani Dharam J, Addo Tayo, Grodin Jerrold, Banerjee Subhash, Brilakis Emmanouil S

机构信息

VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Division of Cardiology (111A), 4500 S. Lancaster Rd, Dallas, TX 75216 USA.

出版信息

J Invasive Cardiol. 2016 Apr;28(4):168-73. Epub 2016 Jan 15.

PMID:26773239

Abstract

OBJECTIVES

We investigated whether side-branch loss during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) could adversely impact clinical outcomes.

BACKGROUND

Side-branch occlusion during PCI has been associated with periprocedural myocardial infarction and higher incidence of major adverse cardiac event (MACE), but has received limited study in CTO-PCI.

METHODS

We retrospectively reviewed the medical records and coronary angiograms for 109 consecutive CTOPCI cases performed at our institution during 2012 and 2013. Post-PCI patency of ≥1 mm diameter side branches and associated clinical outcomes were assessed.

RESULTS

Mean age was 65 ± 8 years and 99.1% of the patients were men. The CTO target vessel was the right coronary artery (54%), circumflex (26%), and left anterior descending artery (20%). Side-branch loss occurred in 28 cases (25.7%) due to antegrade dissection/reentry (n = 9), retrograde dissection/reentry (n = 5), stenting over the branch (n = 12), and dissection during antegrade crossing attempts (n = 2). Recanalization of the occluded side branch was pursued in 8 cases (28.6%) and was successful in 4 patients. Patients with side-branch loss had higher post-PCI increase in CK-MB levels (8.4 ng/mL [interquartile range, 2.7-33.5 ng/mL] vs 1.8 ng/mL [interquartile range, 0.025-6.775 ng/mL]; P<.001) and higher 12-month incidence of all-cause death (17.3% vs 2.8%; P=.02) and cardiovascular death (7.4% vs 0.0%; P=.02).

CONCLUSIONS

Side-branch loss occurs in approximately 1 in 4 CTO-PCIs and is associated with higher risk for periprocedural myocardial infarction and higher mortality.

摘要

目的

我们研究了慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）过程中的边支血管丢失是否会对临床结局产生不利影响。

背景

PCI过程中的边支血管闭塞与围手术期心肌梗死及主要不良心脏事件（MACE）的较高发生率相关，但在CTO-PCI中对此研究有限。

方法

我们回顾性分析了2012年至2013年在我院连续进行的109例CTO-PCI病例的病历和冠状动脉造影。评估了PCI术后直径≥1mm边支血管的通畅情况及相关临床结局。

结果

平均年龄为65±8岁，99.1%的患者为男性。CTO靶血管为右冠状动脉（54%）、回旋支（26%）和左前降支（20%）。28例（25.7%）发生边支血管丢失，原因包括正向夹层/折返（n = 9）、逆向夹层/折返（n = 5）、支架覆盖分支（n = 12）以及正向通过尝试时的夹层（n = 2）。8例（28.6%）尝试对闭塞边支血管进行再通，4例成功。发生边支血管丢失的患者PCI术后CK-MB水平升高幅度更大（8.4 ng/mL[四分位数间距，2.7 - 33.5 ng/mL]对比1.8 ng/mL[四分位数间距，0.025 - 6.775 ng/mL]；P <.001），全因死亡的12个月发生率更高（17.3%对比2.8%；P =.02），心血管死亡发生率也更高（7.4%对比0.0%；P =.02）。