Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
Catheter Cardiovasc Interv. 2020 Nov;96(5):1037-1043. doi: 10.1002/ccd.28616. Epub 2019 Nov 28.
The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications.
We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI.
Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001).
Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.
本研究旨在评估慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中逆行与顺行方法的结果。
逆行方法提高了 CTO PCI 的成功率，但与并发症风险增加相关。
我们对 2000 年至 2019 年 8 月期间发表的比较逆行与顺行 CTO PCI 住院和长期结果的研究进行了荟萃分析。
12 项观察性研究（10240 例患者）符合纳入标准（逆行组 2789 例，顺行组 7451 例）。逆行组治疗的病变 J-CTO 评分更高（2.8 比 1.9，p<0.001）。逆行 CTO PCI 的成功率较低（80.9%比 87.4%，p<0.001）。两种方法的住院死亡率、紧急血运重建和脑血管事件相似。逆行 CTO PCI 与较高的住院心肌梗死（MI）风险相关（比值比[OR] 2.37，95%置信区间[CI] 1.70-3.32，p<0.001）、紧急心包穿刺（OR 2.53，95%CI 1.41-4.51，p=0.002）和对比剂肾病（OR 2.12，95%CI 1.47-3.08；p<0.001）。在平均 48±31 个月的随访期间，逆行穿通的死亡率相似（OR 1.79，95%CI 0.84-3.81，p=0.13），但 MI 发生率较高（OR 2.07，95%CI 1.10-3.88，p=0.02）、靶血管血运重建（OR 1.92，95%CI 1.49-2.46，p<0.001）和靶病变血运重建（OR 2.08，95%CI 1.33-3.28，p=0.001）。
与顺行 CTO PCI 相比，逆行 CTO PCI 用于更复杂的病变，与急性和长期不良事件的风险增加相关。
