Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Texas Health Presbyterian Hospital, Dallas, TX, USA.
J Invasive Cardiol. 2023 Aug;35(8). doi: 10.25270/jic/23.00114.
We examined the effect of atrial fibrillation on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We examined the baseline characteristics and procedural outcomes of 9,166 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023.
Atrial fibrillation was present in 1122 (12%) patients. These patients were older and had a higher incidence of comorbidities, such as hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease, lower left ventricular ejection fraction, and lower eGFR. Their CTOs were more likely to have moderate to severe calcification and longer lesion length. They also had higher mean J-CTO and PROGRESS-CTO complications (Acute MI, MACE, Mortality, Perforation, and Pericardiocentesis) scores. Patients with atrial fibrillation had higher prevalence of uncrossable and undilatable CTO lesions and required longer procedure (107 vs 119 min; P less than .001) and fluoroscopy (40 vs 43 min; P=.005) time. Technical success and MACE, including procedural/in-hospital bleeding, were similar in patients with and without atrial fibrillation. Although the crude incidence of MACE on follow-up (median 61 days) was significantly higher in patients with atrial fibrillation, the latter was not independently associated with adverse events on Cox proportional hazards analysis.
Patients with atrial fibrillation undergoing CTO PCI are older, have more comorbidities, higher lesion complexity, and longer procedure time, but similar technical success and in-hospital MACE. They have higher MACE and mortality during follow-up, but the difference is not significant after adjusting for potential confounding variables.
我们研究了心房颤动对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）结局的影响。
我们检查了 2012 年至 2023 年期间在 39 个美国和非美国中心进行的 9166 例 CTO PCI 的基线特征和手术结果。
1122 例（12%）患者存在心房颤动。这些患者年龄较大，合并症发生率较高，如高血压、血脂异常、心力衰竭、脑血管疾病和外周动脉疾病，左心室射血分数较低，eGFR 较低。他们的 CTO 更有可能存在中度至重度钙化和较长的病变长度。他们的 J-CTO 和 PROGRESS-CTO 并发症（急性心肌梗死、MACE、死亡率、穿孔和心包穿刺）评分也较高。心房颤动患者的不可交叉和不可扩张性 CTO 病变的发生率较高，需要更长的手术（107 分钟比 119 分钟；P 小于 0.001）和透视时间（40 分钟比 43 分钟；P 等于 0.005）。有和没有心房颤动的患者的技术成功率和 MACE（包括手术/住院期间出血）相似。尽管在随访期间（中位数 61 天）有心房颤动的患者的 MACE 发生率明显较高，但在 Cox 比例风险分析中，后者与不良事件无关。
接受 CTO PCI 的心房颤动患者年龄较大，合并症较多，病变复杂性较高，手术时间较长，但技术成功率和住院期间的 MACE 相似。他们在随访期间的 MACE 和死亡率较高，但在调整潜在混杂变量后差异无统计学意义。
