Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Texas Health Presbyterian Hospital, Dallas, Texas, USA.
J Invasive Cardiol. 2024 Sep;36(9). doi: 10.25270/jic/24.00056.
There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.
Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.
Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.
慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的临床和病变特征以及技术存在差异。
我们分析了 2017 年至 2023 年在北美（NA）和欧洲、亚洲和非洲联合地区的 PROGRESS-CTO 注册中心记录的 11503 例 CTO-PCI 手术中的患者和病变特征、技术和结局。
8479 例（74%）手术在 NA 进行。与非 NA 患者相比，NA 患者年龄较大，体重指数较高，糖尿病、高血压、血脂异常、冠心病家族史、既往 PCI 史、冠状动脉旁路移植术和心力衰竭、脑血管疾病和外周动脉疾病的患病率较高。他们的 CTO 更复杂，J-CTO（2.56±1.22 比 1.81±1.24；P<.001）和 PROGRESS-CTO（1.29±1.01 比 1.07±0.95；P<.001）评分更高，长度更长，近端帽模糊、钝/无残端、中重度钙化和近端迂曲的发生率更高。逆行（31.0%比 22.1%；P<.001）和正向夹层和再进入（ADR）（21.2%比 9.2%；P<.001）在 NA 中心更常用，同时血管内超声（69.0%比 10.1%；P<.001）。NA 中心的手术和透视时间较长，而造影剂用量和辐射剂量较低。NA 和非 NA 中心的技术（86.7%比 86.8%；P>.90）和程序（85.4%比 85.8%；P=.70）成功率和住院期间主要不良心血管事件（MACE）（1.9%比 1.7%；P=.40）相似。
与非 NA 患者相比，接受 CTO PCI 的 NA 患者合并症更多，CTO 病变更复杂，更有可能接受逆行和 ADR 治疗，技术成功率和 MACE 相似。
