Kurashiki Central Hospital, Okayama, Japan.
Toyohashi Heart Center, Aichi, Japan.
J Am Coll Cardiol. 2019 Nov 12;74(19):2392-2404. doi: 10.1016/j.jacc.2019.08.1049.
Guidewire manipulation time is rarely used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) strategies.
This study sought to develop an algorithm based on angiographic characteristics and guidewire manipulation time.
This study assessed 5,843 patients undergoing CTO PCI between January 2014 and December 2017 and enrolled in the Japanese CTO-PCI expert registry and analyzed their CTO-PCI strategies, procedural outcomes, and guidewire manipulation time.
Primary retrograde approach was performed on 1,562 patients. The average Japanese CTO score of primary antegrade approach and primary retrograde approach were 1.7 ± 1.1 and 2.3 ± 1.1, respectively (p < 0.001). The overall guidewire and technical success rates were 92.8% and 90.6%, respectively. Median guidewire manipulation time of guidewire success and failure were 56 min (interquartile range [IQR]: 22 to 111 min) and 176 min (IQR: 130 to 229 min), respectively. Median successful guidewire crossing time of single wiring and parallel wiring in the antegrade alone were 23 min (IQR: 11 to 44 min) and 60 min (IQR: 36 to 97 min), and rescue retrograde approach and primary retrograde approach were 126 min (IQR: 87 to 174 min) and 107 min (IQR: 70 to 161 min), respectively (p < 0.001). Significant predictors for antegrade guidewire failure in primary antegrade approach, which were reattempt, CTO length of ≥20 mm, and no stump, did not predict guidewire failure after collateral channel crossing in primary retrograde approach.
Results from a large registry with information on guidewire manipulation time as well as CTO characteristics suggest a redefinition of the current strategy algorithms.
导丝操作时间在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）策略中很少使用。
本研究旨在开发一种基于血管造影特征和导丝操作时间的算法。
本研究评估了 2014 年 1 月至 2017 年 12 月期间在日本 CTO-PCI 专家注册中心接受 CTO-PCI 的 5843 例患者，并分析了他们的 CTO-PCI 策略、手术结果和导丝操作时间。
对 1562 例患者进行了主要逆行入路。正向主要入路和逆行主要入路的日本 CTO 评分分别为 1.7±1.1 和 2.3±1.1（p<0.001）。总的导丝和技术成功率分别为 92.8%和 90.6%。导丝成功和失败的中位导丝操作时间分别为 56 分钟（IQR：22 至 111 分钟）和 176 分钟（IQR：130 至 229 分钟）。单纯正向入路中单线和并行布线成功导丝穿越时间的中位数分别为 23 分钟（IQR：11 至 44 分钟）和 60 分钟（IQR：36 至 97 分钟），而挽救性逆行入路和逆行主要入路分别为 126 分钟（IQR：87 至 174 分钟）和 107 分钟（IQR：70 至 161 分钟）（p<0.001）。正向主要入路中，导丝再次尝试、CTO 长度≥20mm 和无残端是正向导丝失败的显著预测因素，但不能预测逆行主要入路中导丝失败后通过侧支通道的情况。
来自包含导丝操作时间和 CTO 特征信息的大型注册研究的结果表明，需要重新定义当前的策略算法。
