Center for Coronary Heart Disease, Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center for Coronary Heart Disease, Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cardiol. 2024 Nov 1;414:132384. doi: 10.1016/j.ijcard.2024.132384. Epub 2024 Jul 18.
Chronic total occlusions (CTO) occur in about 20% of patients referred for coronary angiography, and right coronary artery (RCA) CTO has been reported in 38-50% of the entire CTO population. Limited data on angiographic and procedural characteristics of RCA-CTO and the risk of adverse cardiac events asks for a detailed study.
From 2010 to 2013, patients with attempted revascularization of at least one CTO lesion were included and followed up to 5 years after PCI. Eligible patients are assigned to RCA-CTO and non-RCA-CTO groups based on their target vessels. The primary endpoint was major adverse cardiovascular events (MACEs; a composite of all-cause death, myocardial infarction (MI) or rehospitalization for heart failure), and secondary endpoints were cardiac death, target lesion revascularization (TLR) and target vessel revascularization (TVR).
The present study included 2659 eligible patients, among which 1285 patients were assigned to the RCA-CTO group, whereas 1374 patients were assigned to the non-RCA-CTO group. Lesions in RCA had longer lesion length, higher J-CTO score, higher rates of severe vessel tortuosity, a higher percentage of Rentrop grade 2-3, and more likely to be re-try lesion than those in LAD or LCX (all P < 0.01). CTO lesions in RCA reached less successful recanalization and post-procedural TIMI 3 flow (all <0.01). Multivariate Cox analysis revealed that RCA-CTO was not associated with primary outcome MACEs. Besides MACEs, RCA-CTO was also not associated with cardiac death, but was significantly associated with TLR and TVR (adjusted HR: 1.37 [95% CI:1.07-1.76], P = 0.01; adjusted HR: 1.43 [95% CI:1.13-1.82], P = 0.003).
RCA-CTO lesions, which had more complex angiographic features, independently contributed to TLR and TVR but not to MACEs or cardiac death in the 5 years of follow-up.
慢性完全闭塞（CTO）约占行冠状动脉造影检查患者的 20%，右冠状动脉（RCA）CTO 占整个 CTO 人群的 38-50%。RCA-CTO 的血管造影和程序特征以及不良心脏事件的风险数据有限，需要进行详细研究。
从 2010 年到 2013 年，纳入了至少一条 CTO 病变血管再血管化的患者，并在 PCI 后随访 5 年。根据靶血管，将符合条件的患者分为 RCA-CTO 组和非 RCA-CTO 组。主要终点是主要不良心血管事件（MACE；全因死亡、心肌梗死（MI）或心力衰竭再住院的复合终点），次要终点是心脏死亡、靶病变血运重建（TLR）和靶血管血运重建（TVR）。
本研究共纳入 2659 例符合条件的患者，其中 1285 例患者被分到 RCA-CTO 组，1374 例患者被分到非 RCA-CTO 组。RCA 病变的长度更长，J-CTO 评分更高，严重血管迂曲的发生率更高，Rantrop 分级 2-3 的比例更高，再尝试病变的可能性也更高，而左前降支（LAD）或左回旋支（LCX）的病变则相反（均 P<0.01）。RCA 的 CTO 病变再通和术后 TIMI 3 级血流的比例更低（均<0.01）。多变量 Cox 分析显示，RCA-CTO 与主要终点 MACE 无关。除了 MACE 外，RCA-CTO 与心脏死亡也无关，但与 TLR 和 TVR 显著相关（校正 HR：1.37 [95%CI：1.07-1.76]，P=0.01；校正 HR：1.43 [95%CI：1.13-1.82]，P=0.003）。
在 5 年的随访中，RCA-CTO 病变的血管造影特征更复杂，独立导致 TLR 和 TVR，但与 MACE 或心脏死亡无关。
