Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2021 May 1;97(6):1162-1173. doi: 10.1002/ccd.29230. Epub 2020 Sep 2.
We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI).
Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown.
Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion).
Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p < .001) and technical success lower (82.4 vs. 94.2%; p < .001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p = .003), but not at 1-year (4.9 vs. 3.3%; p = .29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p < .001) and at 1-year (19.5 vs. 13.9%; p = .03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p = .58).
In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
我们旨在评估逆行与单纯正向经皮冠状动脉介入治疗慢性完全闭塞（CTO PCI）的住院期间和长期结果。
逆行与单纯正向 CTO PCI 后的手术和临床结果尚不清楚。
使用经核心实验室裁定的 OPEN-CTO 登记处，我们比较了逆行与单纯正向 CTO PCI 的结果。主要终点包括住院期间主要不良心脑血管事件（MACCE）（全因死亡、卒、心肌梗死[MI]、紧急心脏手术或临床显著穿孔）和 1 年时的 MACCE（全因死亡、MI、卒、靶病变血运重建或靶血管再闭塞）。
在 OPEN-CTO 登记处的 885 例单支 CTO 手术中，454 例为逆行，431 例为单纯正向。逆行组的病变复杂性更高（J-CTO 评分：2.7 比 1.9；p<0.001），技术成功率更低（82.4%比 94.2%；p<0.001）。逆行组住院期间全因死亡率更高（2%比 0%；p=0.003），但 1 年时无差异（4.9%比 3.3%；p=0.29）。与单纯正向手术相比，逆行组住院期间 MACCE 发生率（全因死亡、卒、MI、紧急心脏手术和临床显著穿孔的复合终点）更高（10.8%比 3.3%；p<0.001），1 年时也更高（19.5%比 13.9%；p=0.03）。在以出院为时间起点的敏感性分析中，逆行与单纯正向 CTO PCI 后 1 年的 MACCE 发生率无差异。逆行与单纯正向组在 1 年时西雅图心绞痛问卷生活质量评分的改善相似（29.9 比 30.4；p=0.58）。
在 OPEN-CTO 登记处，逆行 CTO 手术与住院期间较高的 MACCE 发生率相关，而单纯正向 CTO 手术则与单纯正向 CTO 手术相似；然而，在技术模式之间，包括生活质量改善在内的出院后结果相似。
