Cheng Zichao, Peng Hongyu, Jian Wen, Liu Yanci, Li Haiwei, He Songyuan, Li Yingkai, Zhang Yuchao, Shi Yuchen, Liu Jinghua
Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 100029 Beijing, China.
Rev Cardiovasc Med. 2022 Oct 11;23(10):342. doi: 10.31083/j.rcm2310342. eCollection 2022 Oct.
Several complications can contribute to the risk of shock during the chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedure. However, some patients that develop shock do not exhibit any apparent complications, and few studies to date have discussed the risk of unexplained perioperative shock in patients undergoing CTO PCI. Accordingly, this study was designed with the goal of defining perioperative risk factors linked to the odds of unexplained shock during CTO PCI.
In total, this study analyzed data from 924 patients that underwent CTO PCI without any in-hospital complications from January 2016-August 2021. Cardiologists collected data pertaining to patient clinical characteristics, laboratory findings, angiographic findings, and procedural characteristics. Patients were separated into two groups based upon whether or not they experienced perioperative shock. The relationship between specific variables and perioperative shock incidence was assessed via a multivariable stepwise logistic regression approach. A risk-scoring nomogram was then designed for use as a tool to guide patient risk assessment efforts during PCI procedural planning.
Overall, 4.8% of these patients (44/924) experienced unexplained perioperative shock. Independent predictors associated with unexplained shock during CTO PCI included baseline systolic pressure (odds ratio (OR) 0.968, 95% confidence interval (CI): 0.945-0.991), baseline heart rate (OR 1.055, 95% CI: 1.020-1.091), baseline hemoglobin (OR 0.970, 95% CI: 0.947-0.994), procedure duration (OR 1.008, 95% CI: 1.002-1.015), J-CTO score (OR 1.521, 95% CI: 1.021-2.267), and use of a retrograde approach (OR 3.252, 95% CI: 1.426-7.415). The unbiased C-index estimate was 0.859, and this model exhibited excellent calibration.
The risk of unexplained shock is an important consideration for clinicians performing the CTO PCI procedure. These analyses revealed unexplained shock risk to be independently related to lower baseline systolic pressure, higher baseline heart rate, lower baseline hemoglobin, more procedure time, higher J-CTO score, and more use of a retrograde approach.
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）过程中，多种并发症可导致休克风险。然而，一些发生休克的患者并未表现出任何明显的并发症，并且迄今为止很少有研究讨论CTO PCI患者围手术期不明原因休克的风险。因此，本研究旨在确定与CTO PCI期间不明原因休克几率相关的围手术期风险因素。
本研究共分析了2016年1月至2021年8月期间924例无院内并发症的CTO PCI患者的数据。心脏病专家收集了有关患者临床特征、实验室检查结果、血管造影结果和手术特征的数据。根据患者是否经历围手术期休克将其分为两组。通过多变量逐步逻辑回归方法评估特定变量与围手术期休克发生率之间的关系。然后设计了一个风险评分列线图，用作在PCI手术规划期间指导患者风险评估工作的工具。
总体而言，这些患者中有4.8%（44/924）经历了不明原因的围手术期休克。与CTO PCI期间不明原因休克相关的独立预测因素包括基线收缩压（比值比（OR）0.968，95%置信区间（CI）：0.945 - 0.991）、基线心率（OR 1.055，95% CI：1.020 - 1.091）、基线血红蛋白（OR 0.970，95% CI：0.947 - 0.994）、手术持续时间（OR 1.008，95% CI：1.002 - 1.015）、J-CTO评分（OR 1.521，95% CI：1.021 - 2.267）以及逆行入路的使用（OR 3.252，95% CI：1.426 - 7.415）。无偏C指数估计值为0.859，该模型表现出良好的校准。
不明原因休克的风险是进行CTO PCI手术的临床医生的重要考虑因素。这些分析表明，不明原因休克风险与较低的基线收缩压、较高的基线心率、较低的基线血红蛋白、更长的手术时间、更高的J-CTO评分以及更多地使用逆行入路独立相关。
