Ascension St. John Hospital, Detroit, Michigan.
University of Michigan, Ann Arbor, Michigan.
JACC Cardiovasc Interv. 2020 Jun 8;13(11):1357-1368. doi: 10.1016/j.jcin.2020.02.025. Epub 2020 May 13.
The aim of this study was to describe the performance and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Michigan.
CTO PCI has been associated with reduction in angina, but previous registry analyses showed a higher rate of major adverse cardiac events with this procedure.
To study uptake and outcomes of CTO PCI in Michigan, patients enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry (2010 to 2017) were evaluated. CTO PCI was defined as intervention in a 100% occluded coronary artery ≥3 months old.
Among 210,172 patients enrolled in the registry, 7,389 CTO PCIs (3.5%) were attempted, with 4,614 (58.3%) achieving post-procedural TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. The proportion of PCIs performed on CTOs increased over the study period (from 2.67% in 2010 to 4.48% in 2017). Thirty of 47 hospitals performed >50 CTO interventions in 2017. Pre-procedural angina class ≤2 was present in one-quarter, and functional assessment for ischemia was performed in 46.6% of patients. Major complications occurred in 245 patients (3.3%) and included death (1.4%), post-procedural stroke (0.4%), cardiac tamponade (0.5%), and urgent coronary artery bypass graft surgery (1.3%). Procedural success improved modestly from 44.5% in 2010 to 54.9% in 2017 (p for trend < 0.001). Rates of in-hospital mortality (p for trend = 0.247) and major adverse cardiac event (p for trend = 0.859) for CTO PCI remained unchanged over the study period.
The rate of CTO PCI in Michigan increased over the study period. Although the success rate of CTO PCI has increased modestly in contemporary practice, it remained far below the >80% reported by select high-volume CTO operators. The rate of periprocedural major adverse cardiac events or death remained unchanged over time. These data suggest room for improvement in the selection and functional assessment of CTO lesions before subjecting patients to the increased procedural risk associated with CTO PCI.
本研究旨在描述密歇根州慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的表现和结果。
CTO PCI 与心绞痛减轻相关，但之前的注册分析显示该手术的主要不良心脏事件发生率较高。
为了研究密歇根州 CTO PCI 的应用情况和结果，对参加 BMC2（蓝十字蓝盾密歇根州心血管联合会）注册研究（2010 年至 2017 年）的患者进行了评估。CTO PCI 的定义为在 100%闭塞的冠状动脉内进行≥3 个月的介入治疗。
在注册研究中，210172 例患者中，有 7389 例（3.5%）尝试了 CTO PCI，其中 4614 例（58.3%）术后 TIMI（血栓溶解心肌梗死）血流分级达到 3 级。在研究期间，PCI 治疗 CTO 的比例有所增加（从 2010 年的 2.67%增加到 2017 年的 4.48%）。在 2017 年，有 47 家医院中的 30 家医院完成了>50 例 CTO 介入手术。术前心绞痛分级≤2 级的占四分之一，有 46.6%的患者进行了缺血的功能评估。245 例患者（3.3%）发生了主要并发症，包括死亡（1.4%）、术后卒中（0.4%）、心脏压塞（0.5%）和紧急冠状动脉旁路移植术（1.3%）。手术成功率从 2010 年的 44.5%略有提高到 2017 年的 54.9%（趋势检验 p<0.001）。在研究期间，CTO PCI 的住院死亡率（趋势检验 p=0.247）和主要不良心脏事件（趋势检验 p=0.859）的发生率没有变化。
在研究期间，密歇根州 CTO PCI 的比例有所增加。尽管 CTO PCI 的成功率在当代实践中略有提高，但仍远低于某些高容量 CTO 操作者报告的>80%。围手术期主要不良心脏事件或死亡的发生率随时间变化没有变化。这些数据表明，在将患者置于与 CTO PCI 相关的手术风险增加之前，在选择和功能评估 CTO 病变方面仍有改进的空间。
