Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
Columbia University, New York, New York.
JACC Cardiovasc Interv. 2018 Jul 23;11(14):1325-1335. doi: 10.1016/j.jcin.2018.02.036. Epub 2018 Apr 26.
The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents.
CTO PCI has been evolving with constant improvement of equipment and techniques.
Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia.
The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively.
CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).
本研究旨在确定在美国、欧洲和俄罗斯的 20 个中心，由不同的医生和术者对不同患者进行杂交慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的技术和结果。
随着设备和技术的不断改进，CTO PCI 一直在发展。
通过分析美国、欧洲和俄罗斯 20 个中心 3055 例患者的 3122 例 CTO 介入的临床、血管造影和手术特点，研究 CTO PCI 的当代结果。
患者平均年龄为 65±10 岁，85%为男性，糖尿病（43%）、心肌梗死（46%）、冠状动脉旁路移植术（33%）和先前 PCI（65%）的发生率较高。CTO 靶血管为右冠状动脉（55%）、左前降支（24%）和左回旋支（20%）。平均 J-CTO（日本多中心慢性完全闭塞注册研究）和 PROGRESS CTO（慢性完全闭塞介入治疗前瞻性全球注册研究）评分分别为 2.4±1.3 和 1.3±1.0。总的技术和手术成功率分别为 87%和 85%，院内主要并发症发生率为 3.0%。最终成功的交叉策略为正向导丝升级 52.0%、逆行 27.1%、正向夹层再入 20.9%；40.9%需要≥1 种交叉策略。中位数对比剂用量、空气比释动能辐射剂量、手术和透视时间分别为 270ml（四分位距 200-360ml）、2.9Gy（四分位距 1.7-4.7Gy）、123min（四分位距 81-188min）和 47min（四分位距 29-77min）。
在美国、欧洲和俄罗斯的各种经验丰富的中心，目前 CTO PCI 的成功率高，并发症发生率可接受。（慢性完全闭塞介入治疗前瞻性全球注册研究[PROGRESS CTO]；NCT02061436）。
