Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK.
Anglia Ruskin University, Chelmsford, UK.
EuroIntervention. 2023 Jun 5;19(2):e123-e133. doi: 10.4244/EIJ-D-22-00694.
Randomised studies of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) have shown inconsistent outcomes, suggesting incomplete understanding of this cohort and their coronary physiology. To address this shortcoming, we designed a prospective observational study to measure the recovery of absolute coronary blood flow following successful CTO PCI Aims: We sought to identify patient and procedural characteristics associated with a favourable physiological outcome after CTO PCI.
Consecutive patients with a CTO subtending viable myocardium underwent PCI utilising contemporary techniques and the hybrid algorithm. Immediately after PCI, and at 3-month follow-up, physiological measurements were performed utilising continuous thermodilution.
A total of 81 patients were included with a mean age of 63.6±8.9 years, and 66 (81.5%) were male. Physiological measurements of absolute coronary blood flow in the CTO vessel increased by 30% (p<0.001) and microvascular resistance reduced by 16% (p<0.001) from immediately post-CTO PCI to follow-up assessment. Fractional flow reserve increased by 0.02 (p=0.015) in the same period. Prior coronary artery bypass graft (CABG) and a higher estimated glomerular filtration rate (eGFR) were associated with a larger change in absolute flow. An extraplaque strategy was associated with a smaller change in absolute flow.
Post-CTO PCI, there is a continued augmentation in absolute coronary blood flow and reduction in microvascular resistance from baseline to follow-up at 3 months. Prior CABG and a higher baseline eGFR were predictors of a larger change in absolute coronary flow, whilst an extraplaque final wire path strategy predicted a smaller change. Lastly, the patient characteristics and comorbidities had a larger influence than procedural factors on the observed change in absolute flow.
随机对照研究显示，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）患者的结果不一致，这表明对这一患者群体及其冠状动脉生理特征的认识仍不充分。为解决这一不足，我们设计了一项前瞻性观察性研究，以测量成功的 CTO PCI 后绝对冠状动脉血流的恢复情况。
我们旨在确定与 CTO PCI 后生理结果良好相关的患者和手术特征。
连续纳入有存活心肌的 CTO 病变患者，采用当代技术和杂交算法进行 PCI。PCI 后即刻和 3 个月随访时，使用连续热稀释法进行生理测量。
共纳入 81 例患者，平均年龄 63.6±8.9 岁，66 例（81.5%）为男性。CTO 血管内的绝对冠状动脉血流生理测量值在 PCI 后即刻和随访评估时分别增加了 30%（p<0.001）和减少了 16%（p<0.001），同一时期，血流储备分数增加了 0.02（p=0.015）。先前的冠状动脉旁路移植术（CABG）和较高的估计肾小球滤过率（eGFR）与绝对流量的变化较大相关。非斑块策略与绝对流量的变化较小相关。
CTO PCI 后，绝对冠状动脉血流从基线持续增加，微血管阻力从 PCI 后即刻至 3 个月随访时持续降低。先前的 CABG 和较高的基线 eGFR 是绝对冠状动脉血流变化较大的预测因素，而非斑块最终导丝路径策略则预示着变化较小。最后，患者特征和合并症对观察到的绝对流量变化的影响大于手术因素。
