Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Institute of Medicine, National Research Mordovia State University, Saransk, Russia.
Curr Probl Cardiol. 2024 Dec;49(12):102832. doi: 10.1016/j.cpcardiol.2024.102832. Epub 2024 Sep 17.
Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.
We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).
A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).
Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.
逆行技术显著提高了慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成功率。然而，在 CTO PCI 的逆行技术中，已报道手术时间更长、透视和造影剂使用增加。我们旨在研究 CTO PCI 中逆行技术与顺行技术的住院内和长期结局。
我们检索了 PubMed、Scopus、WOS 和 Cochrane Central 数据库，截至 2023 年 6 月，纳入了所有比较 CTO PCI 中逆行技术与顺行技术的相关研究。我们使用随机效应模型综合了结局数据，使用比值比（OR）或均数差值（MD）及其相应的 95%置信区间（CI）表示效应估计值。
共纳入 18 项研究，包括 21276 例患者。关于住院内结局，顺行技术与较低的 MACE 发生率（OR=0.34，95%CI：0.23 至 0.51）、全因死亡率（OR=0.35，95%CI：0.19 至 0.64）、心肌梗死（OR=0.36，95%CI：0.25 至 0.53）、紧急心包穿刺术（OR=0.27，95%CI：0.16 至 0.46）、造影剂肾病（OR=0.46，95%CI：0.33 至 0.65）、手术并发症（OR=0.52，95%CI：0.33 至 0.83）、靶血管穿孔（OR=0.45，95%CI：0.32 至 0.64）相关，而顺行技术与更高的成功率（OR=1.16，95%CI：1.1 至 1.22）相关。
与顺行技术相比，逆行技术与住院内和长期不良事件的风险增加相关，并且可能更适合于复杂的 CTO 病变。
