Yamamoto Masanori, Tsuchikane Etsuo, Kagase Ai, Shimura Tetsuro, Teramoto Tomohiko, Kimura Masashi, Matsuo Hitoshi, Kawase Yoshiaki, Suzuki Yoriyasu, Kano Seiji, Habara Maoto, Nasu Kenya, Kinoshita Yoshihisa, Terashima Mitsuyasu, Matsubara Tetsuo, Suzuki Takahiko
Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
Cardiovasc Revasc Med. 2018 Jun;19(4):407-412. doi: 10.1016/j.carrev.2017.10.015. Epub 2017 Oct 26.
Interventionists' experience and skills are essential factors for successful chronic total occlusion-percutaneous coronary intervention (CTO-PCI). However, the construction of theoretical strategy independent from interventionists' procedure may also improve it. We sought to assess the feasibility of CTO-PCI using an educational system supported by a single expert proctor.
A total of 160 patients underwent CTO-PCI between 2009 and 2016 at 92 Japanese centers in the Hands-on proctorship project. The CTO-PCI strategy was discussed with all participants and their specialists, before and during the procedure. We divided patients into 2 groups based on the CTO-PCI experience of their interventionist: (1) the less experienced group (CTO-PCI ≤50 cases, n=65) and (2) the more experienced group (CTO-PCI >50 cases, n=95). Baseline characteristics, procedural complications, and clinical outcomes were compared between groups.
No significant differences in patient age, sex, prevalence for coronary risk factors, and lesion complexity was observed between groups. The retrograde approach was used equivalently between groups (55.4% vs. 60.0%, p=0.56), and procedural success rates were similar (96.9% vs. 90.5%, p=0.12). The rate of proctor's bailout for recanalization were not frequent between groups (4.6% vs. 5.3%, p=0.85). No procedure-related mortality was noted in either group. In addition, no significant differences in procedural cardiac complications, including coronary dissection, perforation, or tamponade, were observed between groups (10.8% vs. 14.7%, p=0.47).
The expert-supported CTO-PCI maintained high success rates regardless of interventionists' experience. This highlights the importance of theoretical strategy for the management patients undergoing CTO-PCI.
介入医生的经验和技能是成功进行慢性完全闭塞性冠状动脉介入治疗（CTO-PCI）的关键因素。然而，构建独立于介入医生操作的理论策略也可能改善治疗效果。我们旨在评估在单一专家指导下的教育系统用于CTO-PCI的可行性。
在“实践指导项目”中，2009年至2016年间，共有160例患者在日本92个中心接受了CTO-PCI治疗。在手术前和手术过程中，与所有参与者及其专科医生讨论了CTO-PCI策略。我们根据介入医生的CTO-PCI经验将患者分为两组：（1）经验较少组（CTO-PCI≤50例，n=65）和（2）经验较丰富组（CTO-PCI>50例，n=95）。比较两组的基线特征、手术并发症和临床结果。
两组在患者年龄、性别、冠状动脉危险因素患病率和病变复杂性方面未观察到显著差异。两组逆行途径的使用情况相当（55.4%对60.0%，p=0.56），手术成功率相似（96.9%对90.5%，p=0.12）。两组间导丝引导下再通的救援率不高（4.6%对5.3%，p=0.85）。两组均未观察到与手术相关的死亡。此外，两组在包括冠状动脉夹层、穿孔或心包填塞在内的手术心脏并发症方面也未观察到显著差异（10.8%对14.7%，p=0.47）。
无论介入医生的经验如何，专家支持的CTO-PCI均保持了较高的成功率。这凸显了理论策略在CTO-PCI患者管理中的重要性。
