Januszek Rafał, De Luca Giuseppe, Siłka Wojciech, Bryniarski Leszek, Malinowski Krzysztof Piotr, Surdacki Andrzej, Wańha Wojciech, Bartuś Stanisław, Piotrowska Aleksandra, Bartuś Krzysztof, Pytlak Kamil, Siudak Zbigniew
Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland.
Division of Cardiology, AOU Policlinico G. Martino, University of Messina, 98166 Messina, Italy.
J Clin Med. 2023 Jul 14;12(14):4684. doi: 10.3390/jcm12144684.
(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20-2.32); = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention.
(1) 背景：由于经皮冠状动脉介入治疗（PCI）慢性完全闭塞病变（CTO）的手术操作复杂程度较高，因此有人建议采用多术者方法。本研究旨在评估单术者（SO）与双术者（DO）CTO-PCI方法的手术结果。(2) 方法：本回顾性分析纳入了2014年1月至2020年12月期间波兰侵入性心脏病学手术登记处（ORPKI）收集的数据。为比较DO和SO方法，采用倾向评分匹配以均衡基线特征。(3) 结果：在27788例CTO-PCI病例中，3604例（13%）采用了DO方法。接受DO CTO-PCI的患者穿刺部位出血的发生率低于SO组（0.1%对0.3%，P = 0.03）。SO方法（72.4%）与DO方法（71.2%）的技术成功率（心肌梗死溶栓治疗血流分级2/3的成功血运重建）无差异。此外，多支血管病变（MVD）或左主干冠状动脉疾病（LMCA）的存在（优势比（OR），1.67（95%置信区间（CI），1.20 - 2.32）；P = 0.002），以及每年和总的PCI及CTO-PCI术者手术量较低，可被视为与DO方法相关的因素。(4) 结论：由于本研究具有回顾性，其结果仅应被视为产生假设。DO CTO-PCI并不常见，且是在更可能患有LMCA病变或MVD的患者中进行。协作进行CTO-PCI的术者经验更可能较少。双术者组穿刺部位出血发生率较低；然而，第二术者的参与对干预的技术成功没有影响。
