Amat-Santos Ignacio J, Martin-Yuste Victoria, Fernández-Díaz José Antonio, Martin-Moreiras Javier, Caballero-Borrego Juan, Salinas Pablo, Ojeda Soledad, Rivero Fernando, Núñez Villota Julio, Mohandes Mohsen, Dubois Daniela, Bosa Ojeda Francisco, Rumiz Eva, de la Torre Hernández José M, Jiménez-Mazuecos Jesús, Lacunza Javier, Tejedor Paula, Gómez Itziar, Goncalves-Ramirez Luis R, Rojas Paol, Sabaté Manel, Goicolea Javier, Diego Nieto Alejandro, Jiménez-Fernández Miriam, Escaned Javier, Gonzalo Nieves, Pardo Laura, Cuesta Javier, Miñana Gema, Sanchis Juan, Rojas Sergio, Millán Raúl, Vaquerizo Beatriz, Rodríguez Sara, Lee Dae-Hyun, Morales Francisco J, Gutiérrez Alejandro, López María, Maristany Jaume, Rondán Juan, Galeote Guillermo, Kabbanni Zuheir, Rodríguez Sergio, Teruel Luis, Sadaba Mario, Jurado Alfonso, Mainar Vicente, Sánchez-Rubio Juan, Vinhas Hugo, Fernandes Renato
Servicio de Cardiología, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2019 May;72(5):373-382. doi: 10.1016/j.rec.2018.05.020. Epub 2018 Jun 25.
There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting.
Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers.
A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%.
Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality.
目前关于慢性完全性冠状动脉闭塞（CTO）的经皮再通术（PCI）的益处存在争议。我们的目的是确定在我们的医疗环境中的急性和随访结果。
对24个中心连续接受CTO-PCI的患者进行为期两年的前瞻性登记。
952例患者共进行了1000例CTO-PCI。大多数患者有症状（81.5%），患有慢性缺血性心脏病（59.2%）。15%的患者曾尝试过再通。平均SYNTAX评分为19.5±10.6，17.3%的患者J评分为>2。92例患者（9.2%）采用了逆向技术。成功率为74.9%，在未进行过先前尝试的患者中更高（82.2%对75.2%；P=0.001），J评分≤2的患者中更高（80.5%对69.5%；P=0.002），以及在血管内超声引导的PCI中更高（89.9%对76.2%，P=0.001），血管内超声引导是成功的独立预测因素。相比之下，严重钙化、长度>20mm和近端帽钝圆是再通失败的独立预测因素。手术并发症发生率为7.1%，包括穿孔（3%）、心肌梗死（1.3%）和死亡（0.5%）。在1年的随访中，成功再血管化的患者中有88.2%显示临床改善（对34.8%，P<0.001），这与较低的死亡率相关。在1年的随访中，死亡率为1.5%。
与其他国家登记处相比，伊比利亚登记处接受CTO-PCI的患者显示出相似的复杂性、成功率和并发症。成功再通与功能改善密切相关，这与较低的死亡率有关。
