Wu Xi, Wu Mingxing, Huang Haobo, Liu Zhe, Cai Jie, Zhang Qizhou, Huang He
Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People's Republic of China.
Int J Gen Med. 2023 Sep 1;16:3995-4005. doi: 10.2147/IJGM.S429956. eCollection 2023.
This research aimed to evaluate the procedural and in-hospital clinical outcomes of percutaneous coronary intervention (PCI) for ostial or stumpless chronic total occlusion (CTO) utilizing both the antegrade-only and retrograde approaches.
A comprehensive retrospective examination was conducted on the procedural and in-hospital clinical outcomes of 89 consecutive patients subjected to ostial or stumpless CTO PCI at our institution between April 2015 and October 2022.
The antegrade-only technique demonstrated a superior technical success rate (92.0% vs 71.9%, p = 0.041) and procedural success rate (92.0% vs 68.8%, p = 0.022) in comparison to the retrograde approach (RA). The RA group presented a notably elevated Japanese-CTO (J-CTO) score relative to the antegrade-only approach group (2.45±0.73 vs 1.64±0.70, p < 0.001). The antegrade-only approach group manifested an increased frequency of microchannels at the proximal stump relative to the RA group (56.0% vs 10.9%, p < 0.001). In-hospital major adverse cardiac events (MACE) and in-hospital myocardial infarction (MI) were observed more prevalently in the RA group (18.8% vs 0, p = 0.003; 15.6% vs 0, p = 0.008; respectively). A J-CTO score below 2 and the manifestation of microchannels at the proximal stump were identified as predictors for successful antegrade-only approach PCI for ostial or stumpless CTO (OR: 2.79 [95% CI: 1.92-5.03, P =0.003]; OR: 2.89 [95% CI: 1.32-6.03, P =0.001]; respectively).
Relative to RA PCI for ostial or stumpless CTO, the antegrade-only approach is utilized for less complex CTO lesions and is associated with a diminished probability of in-hospital MACE.
本研究旨在评估采用单纯顺行和逆行方法对开口处或无残端慢性完全闭塞（CTO）进行经皮冠状动脉介入治疗（PCI）的手术及院内临床结局。
对2015年4月至2022年10月期间在本机构接受开口处或无残端CTO PCI的89例连续患者的手术及院内临床结局进行全面回顾性检查。
与逆行方法（RA）相比，单纯顺行技术显示出更高的技术成功率（92.0%对71.9%，p = 0.041）和手术成功率（92.0%对68.8%，p = 0.022）。RA组的日本CTO（J-CTO）评分明显高于单纯顺行方法组（2.45±0.73对1.64±0.70，p <0.001）。单纯顺行方法组近端残端微通道的发生率高于RA组（56.0%对10.9%，p <0.001）。RA组院内主要不良心脏事件（MACE）和院内心肌梗死（MI）的发生率更高（分别为18.8%对0，p = 0.003；15.6%对0，p = 0.008）。J-CTO评分低于2以及近端残端出现微通道被确定为开口处或无残端CTO单纯顺行方法PCI成功的预测因素（OR：2.79 [95% CI：1.92 - 5.03，P = 0.003]；OR：2.89 [95% CI：1.32 - 6.03，P = 0.001]；分别）。
相对于开口处或无残端CTO的RA PCI，单纯顺行方法用于不太复杂的CTO病变，且与院内MACE概率降低相关。
