Zhang Dongfeng, Xing Haoran, Wang Rui, Tian Jinfan, Ju Zhiguo, Zhang Lijun, Chen Hui, He Yi, Song Xiantao
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Feb 28;9:762351. doi: 10.3389/fcvm.2022.762351. eCollection 2022.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions.
This study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion.
In this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, = 0.004) and final success (73.3 vs. 95.2%, = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min.
Grouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.
慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的特点是成功率低且并发症增加。本研究旨在探索一种基于斑块成分的新型简单分类方法，以预测CTO病变在30分钟内导丝（GW）通过情况。
本研究连续纳入在2个月内接受CTO PCI尝试且进行了冠状动脉计算机断层血管造影（CCTA）的个体。根据坏死核心比例将病变分为软CTO组和硬CTO组。
在本研究中，根据坏死核心百分比截断值72.7%，将207个病变分为软CTO组（20.3%）和硬CTO组（79.7%）。硬CTO组在30分钟内成功通过GW的比例（57.6%对85.7%，P = 0.004）和最终成功率（73.3%对95.2%，P = 0.001）远低于软CTO组。对于硬CTO患者，既往尝试失败、近端侧支、弯曲>45度、钙化≥50%横截面积（CSA）以及远端参考直径≤2.5 mm被证明与30分钟内GW失败相关。对于软CTO患者，仅钝性进入被证明是30分钟内GW失败的独立预测因素。
根据坏死核心比例对CTO病变进行分组在预测30分钟内GW通过情况方面是合理且必要的。与具有纤维和/或致密钙化的硬CTO相比，具有坏死核心的软CTO更有可能再通。不同的斑块类型具有不同的预测因素。
