Ks Gopakumar, Iype Mathew, Viswanathan Sunitha, Koshy A George, Gupta Prabha Nini, Sivaprasad K, Radhakrishnan V V
Dept of Cardiology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India.
Dept of Cardiology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India.
Indian Heart J. 2018 Jan-Feb;70(1):15-19. doi: 10.1016/j.ihj.2017.09.002. Epub 2017 Sep 8.
Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful.
This was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded.
A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54±8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n=48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n=93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n=92) had ACS during the previous year and remaining 35.22% (n=49) had ACS prior to that. Single vessel CTO was seen in 89.5% (n=188) and two vessel CTO in 10.5% (n=22). LAD was involved in 36.7% (n=77), RCA in 48.1% (n=101), and LCX in 15.2% (n=32). Procedural success in the first attempt was 68.1% (n=143), which increased to 71.42% (n=150) after the second attempt. CTO interventions were more frequently successful when the calcium was absent or minimal (p-0.05), CTO length was <10mm (p<0.01) and good distal reformation (p<0.01).
慢性完全闭塞（CTO）介入治疗是介入心脏病学中一个具有挑战性的领域。目前，约70%的CTO介入治疗是成功的。
这是一项单中心前瞻性研究，对2014年8月至2015年6月期间因CTO接受经皮冠状动脉介入治疗（PCI）作为择期或临时手术的所有患者进行队列研究。仅纳入正向CTO介入治疗。记录了所有患者的以下数据。
共对210例CTO患者进行了随访（占研究期间PCI总数（2353例）的8.9%）。平均年龄为56.54±8.9岁。在该研究中，69例患者（32.9%）表现为慢性稳定型心绞痛，其余患者有急性冠状动脉综合征病史，其中22.9%（n = 48）有不稳定型心绞痛（UA）或非ST段抬高型心肌梗死（NSTEMI），44.2%（n = 93）有ST段抬高型心肌梗死（STEMI）。在有ACS病史的患者中，64.78%（n = 92）在过去一年中有ACS，其余35.22%（n = 49）在此之前有ACS。单支血管CTO见于89.5%（n = 188），双支血管CTO见于10.5%（n = 22）。左前降支（LAD）受累的占36.7%（n = 77），右冠状动脉（RCA）受累的占48.1%（n = 101），左旋支（LCX）受累的占15.2%（n = 32）。首次尝试的手术成功率为68.1%（n = 143），第二次尝试后升至71.42%（n = 150）。当无钙化或钙化极少（p = 0.05）、CTO长度<10mm（p<0.01）且远端重塑良好（p<0.01）时，CTO介入治疗更常成功。
