Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA.
Int J Cardiol. 2022 Sep 1;362:42-46. doi: 10.1016/j.ijcard.2022.04.057. Epub 2022 Apr 26.
The prevalence, treatment, and outcomes of balloon undilatable lesions encountered in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study.
We examined the clinical characteristics and procedural outcomes of balloon undilatable lesions in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).
Of 6535 CTO PCIs performed between 2012 and 2022, 558 (8.5%) lesions were balloon undilatable. In this subset, patients were older (mean age 67 ± 10 vs. 64 ± 10, p < 0.001) and had higher prevalence of comorbidities: diabetes mellitus (54% vs. 40%, p < 0.001), prior PCI (71% vs. 59%, p < 0.001), prior myocardial infarction (52% vs. 45%, p = 0.003), and prior coronary artery bypass graft surgery (44% vs. 25%, p < 0.001). The CTO lesion length was estimated to be 34 ± 23 mm, mean J-CTO score was 2.9 ± 1.1 and mean PROGRESS-CTO score was 1.4 ± 1.0. A cutting balloon was used in 27%, a scoring balloon in 15%, laser in 14%, rotational atherectomy in 28%, orbital atherectomy in 10%, intravascular lithotripsy in 1% and other modalities/approaches in 5%. Balloon undilatable lesions had lower technical success (90.9% vs. 93.8%, p = 0.007) and higher incidence of major adverse cardiovascular events (MACE) (composite of in-hospital death, acute myocardial infarction, stroke, re-PCI, emergency CABG, and pericardiocentesis) (5.0% versus 1.3%, p < 0.001).
Approximately 1 in 12 CTO (8.5%) lesions are balloon undilatable. Treatment of balloon undilatable lesions is associated with lower technical success and higher in-hospital MACE.
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，球囊无法扩张病变的流行率、治疗方法和结果受到的关注有限。
我们研究了前瞻性全球 CTO 介入研究（PROGRESS-CTO，NCT02061436）中球囊无法扩张病变的临床特征和介入治疗结果。
在 2012 年至 2022 年间进行的 6535 例 CTO PCI 中，558 例（8.5%）病变为球囊无法扩张。在这一组中，患者年龄更大（平均年龄 67±10 岁 vs. 64±10 岁，p<0.001），合并症发生率更高：糖尿病（54% vs. 40%，p<0.001）、既往 PCI（71% vs. 59%，p<0.001）、既往心肌梗死（52% vs. 45%，p=0.003）和既往冠状动脉旁路移植术（44% vs. 25%，p<0.001）。CTO 病变长度估计为 34±23mm，平均 J-CTO 评分 2.9±1.1，平均 PROGRESS-CTO 评分 1.4±1.0。切割球囊使用率为 27%，切割球囊使用率为 15%，激光使用率为 14%，旋磨术使用率为 28%，轨道旋磨术使用率为 10%，血管内碎石术使用率为 1%，其他方式/方法使用率为 5%。球囊无法扩张病变的技术成功率较低（90.9% vs. 93.8%，p=0.007），主要不良心血管事件（MACE）发生率较高（住院期间死亡、急性心肌梗死、卒中和再次 PCI、紧急 CABG 和心包穿刺的复合终点）（5.0% vs. 1.3%，p<0.001）。
大约每 12 例 CTO（8.5%）病变中就有 1 例为球囊无法扩张。球囊无法扩张病变的治疗与较低的技术成功率和更高的住院期间 MACE 发生率相关。
