慢性完全闭塞病变介入治疗同期处理非慢性完全闭塞病变的影响。

Impact of concomitant treatment of non-chronic total occlusion lesions at the time of chronic total occlusion intervention.

机构信息

Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.

Columbia University, New York, NY, USA.

出版信息

Int J Cardiol. 2020 Jan 15;299:75-80. doi: 10.1016/j.ijcard.2019.06.077. Epub 2019 Jul 3.

DOI:10.1016/j.ijcard.2019.06.077

PMID:31301862

Abstract

BACKGROUND

During chronic total occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated.

METHODS

We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry.

RESULTS

Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p < 0.01), and less likely to undergo PCI of a right coronary artery (RCA) CTO (46% vs. 58%, p < 0.01). The most common non-CTO lesion location was the left anterior descending artery (31%), followed by the circumflex (29%) and the RCA (25%).Combined non-CTO and CTO-PCI procedures had similar technical (88% vs. 87%, p = 0.33) and procedural (85% vs. 85%, p = 0.74) success and major in-hospital complication rates (3.4% vs. 2.7%, p = 0.23), but had longer procedure duration (131 [88, 201] vs. 117 [75, 179] minutes, p < 0.01), higher patient air kerma radiation dose (3.0 [1.9, 4.8] vs. 2.8 [1.5, 4.6] Gray, p < 0.01) and larger contrast volume (300 [220, 380] vs. 250 [180, 350] ml, p < 0.01).

CONCLUSIONS

Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.

摘要

背景

在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，有时也会同时处理非 CTO 病变。

方法

我们比较了 2012 年至 2018 年间在 21 个中心进行的 3598 例 CTO PCI 中同时处理非 CTO 病变与仅处理 CTO 病变的临床和手术特征及结局。

结果

在同时处理非 CTO 病变的 814 例患者中，患者年龄更大（65±10 岁 vs. 64±10 岁，p=0.03），更可能表现为急性冠脉综合征（32% vs. 23%，p<0.01），且较少接受右冠状动脉（RCA）CTO 介入治疗（46% vs. 58%，p<0.01）。最常见的非 CTO 病变部位是左前降支（31%），其次是回旋支（29%）和 RCA（25%）。同时处理非 CTO 和 CTO-PCI 的手术具有相似的技术成功率（88% vs. 87%，p=0.33）和手术成功率（85% vs. 85%，p=0.74）和主要院内并发症发生率（3.4% vs. 2.7%，p=0.23），但手术时间更长（131[88，201]分钟 vs. 117[75，179]分钟，p<0.01），患者体表空气比释动能辐射剂量更高（3.0[1.9，4.8]Gy 比 2.8[1.5，4.6]Gy，p<0.01）和造影剂用量更大（300[220，380]ml 比 250[180，350]ml，p<0.01）。