病变长度对慢性完全闭塞性经皮冠状动脉介入治疗结果的影响：来自PROGRESS-CTO注册研究的见解。
Impact of lesion length on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.
作者信息
Rempakos Athanasios, Simsek Bahadir, Kostantinis Spyridon, Karacsonyi Judit, Choi James W, Poommipanit Paul, Khatri Jaikirshan J, Jaber Wissam, Rinfret Stephane, Nicholson William, Gorgulu Sevket, Jaffer Farouc A, Chandwaney Raj, Koutouzis Michael, Tsiafoutis Ioannis, Alaswad Khaldoon, Krestyaninov Oleg, Khelimskii Dmitrii, Karmpaliotis Dimitrios, Uretsky Barry F, Patel Mitul P, Mahmud Ehtisham, Potluri Srinivasa, Rangan Bavana V, Mastrodemos Olga C, Allana Salman, Sandoval Yader, Burke Nicholas M, Brilakis Emmanouil S
机构信息
Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, TX, USA.
出版信息
Catheter Cardiovasc Interv. 2023 Mar;101(4):747-755. doi: 10.1002/ccd.30581. Epub 2023 Feb 5.
BACKGROUND
The impact of occlusion length on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
METHODS
We examined the clinical and angiographic characteristics and procedural outcomes of 10,335 CTO PCIs at 42 US and non-US centers between 2012 and 2022. The cohort was divided into two groups based on lesion length (≥20 mm vs. <20 mm).
RESULTS
Long lesions were present in 7208 (70%) patients. Comorbidities were more common in patients with long CTOs. Compared with short lesions, long lesions had higher J-CTO score (2.8 ± 1.1 vs. 1.3 ± 1; p < 0.001) and retrograde wiring was more often the initial (15.5% vs. 4.0%; p < 0.001) and successful (22.8% vs. 8.2%; p < 0.001) crossing strategy. Long lesions were more likely to require longer procedure (123 vs. 91 min; p < 0.001) and fluoroscopy (47.1 vs. 32.2 min; p < 0.001) time, larger contrast volume (218 vs. 200 mL; p < 0.001) and higher air kerma radiation dose (2.4 vs. 1.7 Gy; p < 0.001). After adjusting for potential confounders, long lesions were associated with lower technical success (odds ratio [OR]: 0.91 per 10 mm increase; 95% confidence interval [CI]: 0.88, 0.94) and higher major adverse cardiovascular events (MACE) (OR: 1.08 per 10 mm increase; 95% CI: 1.02, 1.15).
CONCLUSIONS
CTO PCI of long occlusions is independently associated with lower rates of technical success and higher rates of in-hospital MACE.
背景
闭塞长度对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的操作技术和结果的影响研究有限。
方法
我们研究了2012年至2022年间美国和非美国42个中心10335例CTO PCI的临床和血管造影特征及操作结果。根据病变长度（≥20毫米与<20毫米）将队列分为两组。
结果
7208例（70%）患者存在长病变。长CTO患者的合并症更常见。与短病变相比，长病变的J-CTO评分更高（2.8±1.1对1.3±1；p<0.001），逆行导丝更常作为初始（15.5%对4.0%；p<0.001）和成功（22.8%对8.2%；p<0.001）的通过策略。长病变更可能需要更长的手术时间（123对91分钟；p<0.001）和透视时间（47.1对32.2分钟；p<0.001）、更大的造影剂用量（218对200毫升；p<0.001）和更高的空气比释动能辐射剂量（2.4对1.7戈瑞；p<0.001）。在调整潜在混杂因素后，长病变与较低的技术成功率（每增加10毫米的优势比[OR]：0.91；95%置信区间[CI]：0.88，0.94）和较高的主要不良心血管事件（MACE）发生率（每增加10毫米的OR：1.08；95%CI：1.02，1.15）相关。
结论
长闭塞病变的CTO PCI与较低的技术成功率和较高的院内MACE发生率独立相关。
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