Center of Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
BMC Cardiovasc Disord. 2023 Jan 16;23(1):23. doi: 10.1186/s12872-023-03045-w.
To evaluate the long-term outcome after re-attempt CTO-PCI.
This is a retrospective cohort study that included 113 re-attempt CTO-PCI patients who were consecutively registered from January 2019 to December 2020 at Beijing Anzhen Hospital's Center of Coronary Artery Disease. All patients were divided into two groups based on procedural success or failure. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality, myocardial infarction and target vessel revascularization (TVR). The secondary endpoint was angina after PCI.
Overall, the successful re-attempt CTO-PCI was archived in 77 patients, the failed CTO-PCI was performed in 36 patients. After a median follow-up of 21.7 months (interquartile range: 10.9-26.0), the incidence of the primary outcome was significantly lower in the success group [14.2% vs. 38.9%, adjusted hazard ratio (HR) 0.351, 95% CI 0.134-0.917, P = 0.033], mainly driven by the reduction of TVR (9.1% vs. 30.6%, adjusted HR 0.238, 95% CI: 0.078-0.72, P = 0.011). Furthermore, patients who had successful re-attempt CTO-PCI had a lower risk of angina after PCI (27.3% vs.61.1%, adjusted HR 0.357, 95% CI 0.167-0.76, P = 0.008). The risk factors of TVR in the patients with successful re-attempt CTO-PCI were stent length > 100 mm (adjusted HR 21.805, 95% CI 1.765-269.368, P = 0.016) and J-CTO score > 3(adjusted HR: 9.733, 95% CI:1.533-61.797, P = 0.016).
For the patients with previous CTO-PCI failure, a successful re-attempt CTO-PCI was associated with significantly lower MACE, which was primarily driven by a lower TVR rate. More complex CTO lesions and longer stents were the independent predictors of TVR after successful CTO-PCI.
评估再次尝试 CTO-PCI 的长期结果。
这是一项回顾性队列研究，纳入了 2019 年 1 月至 2020 年 12 月在北京安贞医院冠心病中心连续登记的 113 例再次尝试 CTO-PCI 的患者。所有患者根据手术成功或失败分为两组。主要终点是主要不良心脏事件（MACE），即全因死亡率、心肌梗死和靶血管血运重建（TVR）的综合结果。次要终点是 PCI 后的心绞痛。
总体而言，77 例患者成功进行了再次尝试 CTO-PCI，36 例患者进行了失败的 CTO-PCI。中位随访 21.7 个月（四分位距：10.9-26.0）后，成功组的主要结局发生率显著降低[14.2%比 38.9%，调整后的危险比（HR）0.351，95%可信区间（CI）0.134-0.917，P=0.033]，主要归因于 TVR 的减少（9.1%比 30.6%，调整后的 HR 0.238，95%CI：0.078-0.72，P=0.011）。此外，成功进行再次尝试 CTO-PCI 的患者 PCI 后心绞痛的风险较低[27.3%比 61.1%，调整后的 HR 0.357，95%CI 0.167-0.76，P=0.008]。成功进行再次尝试 CTO-PCI 的患者中 TVR 的危险因素是支架长度>100mm（调整后的 HR 21.805，95%CI 1.765-269.368，P=0.016）和 J-CTO 评分>3（调整后的 HR：9.733，95%CI：1.533-61.797，P=0.016）。
对于之前 CTO-PCI 失败的患者，再次尝试 CTO-PCI 成功与显著较低的 MACE 相关，这主要归因于 TVR 发生率较低。更复杂的 CTO 病变和更长的支架是成功进行 CTO-PCI 后 TVR 的独立预测因素。
