Pillai Ajith Ananthakrishna, Ramasamy Sakthivel, Jagadheesan Kabilan S, Satheesh Santhosh, Selvaraj Raja J, Jayaraman Balachander
Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India.
Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India.
Indian Heart J. 2019 Jan-Feb;71(1):65-73. doi: 10.1016/j.ihj.2018.12.003. Epub 2019 Jan 26.
Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital.
This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up.
A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (p = 0.001), calcifications (p ≤ 0.001), and blunt stump (p = 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%, p < 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization.
The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.
慢性完全闭塞病变（CTO）仍是经皮介入治疗中具有挑战性的病变亚组。由于对其解剖结构的认识不断提高以及专用硬件的出现使技术水平得以提升，过去十年间该亚组的经皮冠状动脉介入治疗（PCI）有了大幅增长。我们试图研究一家印度公立医院中CTO PCI的治疗结果。
这是一项关于CTO PCI的单中心非随机描述性随访研究。终点指标为手术成功率、即刻及晚期不良心血管事件[主要不良心脏事件（MACE）]以及随访时心绞痛和左心室功能的变化。
共治疗了389处CTO病变，成功率为87%（339/389）。日本慢性完全闭塞（J-CTO）评分的平均值为1.78±0.12（均值±标准差）。对J-CTO评分的不同血管造影成分进行多因素分析发现，迂曲（p = 0.001）、钙化（p≤0.001）和钝端（p = 0.007）是手术失败的独立预测因素。围手术期死亡率低于1%，非危及生命的并发症约为4%。手术失败组的MACE发生率（60%）显著高于手术成功组（5.3%，p<0.001）。成功进行CTO PCI并实现完全血运重建后，左心室射血分数（LVEF）有所增加。
该登记研究中CTO PCI的成功率约为87%。手术成功后，即刻和长期临床结果较好，MACE较低（5%）。一个关键的结果变量是成功进行CTO PCI后患者的LVEF增加。总体围手术期并发症约为5.5%，但大多数不危及生命。
