Hirai Taishi, Grantham J Aaron, Sapontis James, Cohen David J, Marso Steven P, Lombardi William, Karmpaliotis Dimitri, Moses Jeffrey, Nicholson William J, Pershad Ashish, Wyman R Michael, Spaedy Anthony, Cook Stephen, Doshi Parag, Federici Robert, Nugent Karen, Gosch Kensey L, Spertus John A, Salisbury Adam C
University of Chicago Medical Center, Chicago, Illinois.
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Catheter Cardiovasc Interv. 2018 May 1;91(6):1035-1042. doi: 10.1002/ccd.27380. Epub 2017 Oct 25.
We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI.
Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI.
We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression.
SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4-19.7, P = 0.02) greater SAQ SS improvement through 30 days.
SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM.
我们旨在确定在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）失败后，内膜下斑块修饰（SPM）对早期健康状况的影响。
一些杂交手术操作者采用的一种技术是，在CTO PCI失败时故意扩张内膜下间隙，以促进血流通过夹层平面并提高重复PCI尝试的成功率，并且尽管CTO PCI失败，但该技术可能通过恢复远端血管血流来改善健康状况。
我们在一个12中心的CTO PCI注册研究中，对138例行CTO PCI失败的患者进行了研究。通过比较接受和未接受SPM的CTO PCI失败患者的院内结局来评估安全性。使用西雅图心绞痛问卷总结评分（SAQ SS）对SPM与健康状况之间的关联进行量化，并使用多变量回归确定SPM与SAQ SS之间的关联。
59例患者（42.8%）接受了SPM。接受和未接受SPM的患者并发症发生率相似。在1个月时，与未接受SPM的患者相比，接受SPM治疗的患者SAQ SS升高幅度更大（28.3±21.7对16.8±20.2，P = 0.012），并且通过30天的观察，SPM与SAQ SS改善幅度平均增加10.5分（95%CI 1.4 - 19.7，P = 0.02）相关。
在几乎一半的CTO PCI失败病例中进行了SPM，且与手术并发症增加无关。SPM与30天时患者报告的更好健康状况独立相关。需要进一步研究来评估在SPM后健康状况显著改善的患者中后续PCI的必要性。
