Danek Barbara A, Karatasakis Aris, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Patel Mitul P, Bahadorani John, Lombardi William L, Wyman R Michael, Grantham J Aaron, Kandzari David E, Lembo Nicholas J, Doing Anthony H, Toma Catalin, Moses Jeffrey W, Kirtane Ajay J, Ali Ziad A, Parikh Manish, Garcia Santiago, Nguyen-Trong Phuong-Khanh, Karacsonyi Judit, Alame Aya J, Kalsaria Pratik, Thompson Craig, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Henry Ford Hospital, Detroit, Michigan, USA.
Can J Cardiol. 2016 Dec;32(12):1433-1439. doi: 10.1016/j.cjca.2016.04.007. Epub 2016 Apr 22.
We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres.
Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions.
Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.
我们试图确定病变年龄对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的操作技术和结果的影响。
我们研究了2012年至2016年间在美国11个经验丰富的中心进行的394例CTO PCI的特征和结果，并获取了病变年龄的数据。
患者的平均年龄为66±10岁，85.6%为男性。总体技术成功率和手术成功率分别为90.1%和87.5%。16例患者（4.1%）发生了主要不良心血管事件（MACE）。病变的平均年龄和中位数年龄分别为43±62个月和12个月（四分位间距，3 - 64个月）。根据病变年龄（3 - 5个月、5 - 36.3个月和> 36.3个月）将患者分为三分位数。病变年龄越大，患者年龄越大（68±8岁 vs 65±10岁 vs 64±11岁；P = 0.009），既往冠状动脉旁路移植术的比例越高（62% vs 42% vs 30%；P < 0.001），中度/重度钙化的比例越高（75% vs 53% vs 59%；P = 0.001）。年龄较大的病变更常需要采用逆向技术和顺向夹层分离/重新进入技术来成功通过病变。对于年龄较大和较小的闭塞病变，技术成功率（87.8% vs 89.6% vs 93.0%；P = 0.37）、手术成功率（86.3% vs 87.4% vs 89.0%；P = 0.80）或MACE发生率（3.1% vs 3.0% vs 6.3%；P = 0.31）没有差异。
年龄较大的CTO病变表现出血管造影的复杂性，更常需要采用逆向技术或顺向夹层分离/重新进入技术。年龄较大的CTO病变可以实现较高的技术成功率和手术成功率，且MACE发生率可接受。病变年龄似乎不太可能是CTO PCI成功的重要决定因素。
