Tajti Peter, Alaswad Khaldoon, Karmpaliotis Dimitri, Jaffer Farouc A, Yeh Robert W, Patel Mitul, Mahmud Ehtisham, Choi James W, Burke M Nicholas, Doing Anthony H, Toma Catalin, Uretsky Barry, Holper Elizabeth, Wyman R Michael, Kandzari David E, Garcia Santiago, Krestyaninov Oleg, Khelimskii Dmitrii, Koutouzis Michalis, Tsiafoutis Ioannis, Jaber Wissam, Samady Habib, Moses Jeffrey W, Lembo Nicholas J, Parikh Manish, Kirtane Ajay J, Ali Ziad A, Doshi Darshan, Xenogiannis Iosif, Rangan Bavana V, Ungi Imre, Banerjee Subhash, Brilakis Emmanouil S
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.
Henry Ford Hospital, Detroit, Michigan.
Am J Cardiol. 2018 Aug 1;122(3):381-387. doi: 10.1016/j.amjcard.2018.04.021. Epub 2018 May 1.
The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.
对于在同一手术过程中接受多支慢性完全闭塞病变（CTO）经皮冠状动脉介入治疗（PCI）的患者，其发生率及治疗结果的研究有限。我们比较了来自美国、欧洲和俄罗斯20个中心的患者，在同一手术过程中接受单支CTO治疗与多支CTO治疗的临床、血管造影特征及手术结果。共纳入2955例患者：平均年龄65±10岁，85%为男性，既往心肌梗死发生率高（46%），既往冠状动脉旁路移植手术发生率高（33%）。58例患者（2.0%）在同一手术过程中尝试处理多支CTO病变，其中70%位于不同的主要心外膜动脉。与接受单支CTO PCI的患者相比，同一手术过程中接受多支CTO PCI的患者具有相似的日本CTO评分（J-CTO）（2.4±1.3 vs 2.5±1.3，p = 0.579）和慢性完全闭塞病变干预研究全球前瞻性注册（Prospective Global Registry for the Study of Chronic Total Occlusion Intervention）评分（1.5±1.2 vs 1.3±1.0，p = 0.147）。多支CTO PCI组技术成功率相似（86% vs 87%，p = 0.633），但院内主要并发症风险更高（10.3% vs 2.7%，p = 0.005），因此手术成功率在数值上更低（79% vs 85%，p = 0.197）。多支CTO PCI组院内死亡率更高（5.2% vs 0.5%，p = 0.005）、卒中发生率更高（5.2% vs 0.2%，p<0.001）、手术时间更长（162[117至242]分钟vs 122[80至186]分钟，p<0.001）以及辐射剂量更高（3.6[2.1至6.4]Gy vs 2.9[1.7至4.7]Gy，p = 0.033）。总之，对于需要血运重建的多支CTO病变患者，分期血运重建可能是首选方法，因为单次手术治疗与围手术期并发症风险较高相关。
