Chang Hao-Yun, Huang Ching-Chang, Hung Chi-Sheng, Meng Shih-Wei, Lin Mao-Shin, Chen Ying-Hsien, Yeh Chih-Fan, Kao Hsien-Li
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
Am J Cardiol. 2024 Jan 1;210:93-99. doi: 10.1016/j.amjcard.2023.10.027. Epub 2023 Oct 14.
Successful collateral channel (CC) crossing is an essential step in retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). We previously developed a dedicated CC score based on CC size and tortuosity to facilitate target CC selection. Validation and comparison to other scoring systems were lacking. Thus, the aims of this study were to (1) validate the CC score in a larger independent cohort, and (2) compare its accuracy and clinical usefulness with the J-channel score. All coronary CTO PCIs attempted by experienced high-volume operators from January 2017 to December 2021 were enrolled. The CC and J-channel scores were calculated for all attempted CCs with bi-plane high-resolution cine angiography images. CC crossing success was defined as guidewire reaching the distal true lumen retrogradely. In total, 502 patients who received CTO PCI were included. The retrograde approach was utilized in 244 target CTOs, and a total of 329 CCs were attempted. The overall CC crossing rate was 67.8% (223 of 329) and final technical success rate 92.2% (225 of 244). The average CC score was 2.0 and average J-channel score was 0.71. The sensitivity and specificity of successful CC crossing with the CC score ≥2 were 81.2%, and 84.0%, respectively. Comparison between the CC score (area under the curve 0.87; 95% confidence interval 0.83 to 0.90) and the J-channel score (area under the curve 0.61, 95% confidence interval 0.55 to 0.67) demonstrated superior predictive performance of the CC score (p <0.001). The CC score was an easy-to-use and accurate tool for the prediction of successful CC crossing in retrograde CTO PCI. The CC score can help operators select the ideal target CC, thereby facilitating final procedural success.
成功的侧支通道（CC）跨越是逆向慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的关键步骤。我们之前基于CC的大小和迂曲度开发了一种专门的CC评分，以促进目标CC的选择。该评分缺乏与其他评分系统的验证和比较。因此，本研究的目的是：（1）在更大的独立队列中验证CC评分；（2）将其准确性和临床实用性与J通道评分进行比较。纳入了2017年1月至2021年12月期间由经验丰富的高年资术者尝试的所有冠状动脉CTO PCI病例。使用双平面高分辨率电影血管造影图像为所有尝试的CC计算CC和J通道评分。CC跨越成功定义为导丝逆行到达远端真腔。总共纳入了502例接受CTO PCI的患者。244个目标CTO采用了逆向入路，共尝试了329条CC。CC的总体跨越率为67.8%（329条中的223条），最终技术成功率为92.2%（244条中的225条）。CC评分的平均值为2.0，J通道评分的平均值为0.71。CC评分≥2时成功CC跨越的敏感性和特异性分别为81.2%和84.0%。CC评分（曲线下面积0.87；95%置信区间0.83至0.90）与J通道评分（曲线下面积0.61，95%置信区间0.55至0.67）的比较显示，CC评分具有更好的数据预测性能（p<0.001）。CC评分是预测逆向CTO PCI中CC成功跨越的一种易于使用且准确的工具。CC评分可帮助术者选择理想的目标CC，从而促进最终手术成功。
