Kostantinis Spyridon, Alaswad Khaldoon, Karmpaliotis Dimitri, Jaffer Farouc, Jaber Wissam, Nicholson William, Rinfret Stephane, Khatri Jaikirshan, Poommipanit Paul, Karacsonyi Judit, Simsek Bahadir, Vemmou Evangelia, Nikolakopoulos Ilias, Koutouzis Michalis, Tsiafoutis Ioannis, Riley Robert, Sheikh Abdul, Patel Mitul, Gorgulu Sevket, ElGuindy Ahmed M, Goktekin Omer, Abi Rafeh Nidal, Rangan Bavana V, Garcia Santiago, Burke M Nicholas, Brilakis Emmanouil S
Center for Complex Coronary Interventions, Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.
J Invasive Cardiol. 2022 Sep;34(9):E672-E677. doi: 10.25270/jic/22.00059. Epub 2022 Aug 12.
The retrograde approach to coronary chronic total occlusions (CTOs) can be used as the initial crossing strategy (primary retrograde) or after failure of antegrade crossing attempts (secondary retrograde).
We compared baseline clinical and angiographic characteristics and procedural outcomes of primary vs secondary retrograde crossing for CTO percutaneous coronary intervention (PCI) among 2789 procedures performed at 34 centers between 2012 and 2021.
Retrograde CTO-PCI was performed as the primary crossing strategy in 1086 cases (38.9%) and as a secondary approach in 1703 cases (61.1%). Patients in the primary group had slightly lower left ventricular ejection fraction (49.1% vs 50.4%; P=.02), were more likely to have had prior coronary artery bypass graft surgery (52.9% vs 38.4%; P<.001), and had higher J-CTO (3.31 ± 0.98 vs 2.99 ± 1.09; P<.001) and PROGRESS-CTO scores (1.47 ± 0.92 vs 1.29 ± 0.99; P<.001). Technical (81.4% vs 77.3%; P=.01) and procedural success rates (78.6% vs 74.1%; P<.01) were higher in the primary retrograde group, with no difference between in-hospital major adverse event rates (4.3% vs 4.0%; P=.66). Contrast volume (250 mL [interquartile range (IQR), 176-347] vs 270 mL [IQR, 190-367]; P<.001) and procedure time (175 minutes [IQR, 127-233] vs 180 minutes [IQR, 142-236]; P<.001) were lower in the primary group.
Use of retrograde approach as the primary crossing strategy is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with secondary retrograde CTO-PCI.
冠状动脉慢性完全闭塞（CTO）的逆行介入方法可作为初始开通策略（原发性逆行）或在顺行开通尝试失败后使用（继发性逆行）。
我们比较了2012年至2021年期间在34个中心进行的2789例CTO经皮冠状动脉介入治疗（PCI）中，原发性与继发性逆行开通的基线临床和血管造影特征及手术结果。
逆行CTO-PCI作为原发性开通策略实施了1086例（38.9%），作为继发性方法实施了1703例（61.1%）。原发性组患者的左心室射血分数略低（49.1%对50.4%；P=0.02），更有可能接受过冠状动脉旁路移植手术（52.9%对38.4%；P<0.001），且J-CTO评分更高（3.31±0.98对2.99±1.09；P<0.001）和PROGRESS-CTO评分更高（1.47±0.92对1.29±0.99；P<0.001）。原发性逆行组的技术成功率（81.4%对77.3%；P=0.01）和手术成功率（78.6%对74.1%；P<0.01）更高，住院期间主要不良事件发生率无差异（4.3%对4.0%；P=0.66）。原发性组的造影剂用量（250 mL[四分位数间距（IQR），176 - 347]对270 mL[IQR，190 - 367]；P<0.001）和手术时间（175分钟[IQR，127 - 233]对180分钟[IQR，142 - 236]；P<0.001）更低。
与继发性逆行CTO-PCI相比，将逆行方法作为原发性开通策略与更高的技术和手术成功率以及相似的住院期间主要不良心脏事件发生率相关。
