异常冠状动脉慢性完全闭塞经皮冠状动脉介入治疗：来自 PROGRESS CTO 注册研究的见解。
Chronic total occlusion percutaneous coronary intervention of anomalous coronary arteries: insights from the PROGRESS CTO registry.
机构信息
The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, USA.
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
出版信息
Catheter Cardiovasc Interv. 2024 Nov;104(6):1148-1158. doi: 10.1002/ccd.31248. Epub 2024 Oct 4.
BACKGROUND
There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).
METHODS
We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.
RESULTS
Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI).
CONCLUSIONS
CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.
背景
关于异常起源冠状动脉（ACA）中的慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的频率和结果，信息有限。
方法
我们检查了在 2012 年至 2023 年间，46 个美国和非美国中心的 14470 例 CTO PCI 中，46 个美国和非美国中心的 14173 例 CTO PCI 中 CTO PCI 的临床和血管造影特征和程序结果。
结果
在 14470 例 CTO PCI 中，有 36 例（0.24%）为 CTO PCI 在 ACA 中。ACA 患者的基线特征与无 ACA 的患者相似。在发现 CTO 病变的 ACA 类型如下：右冠状动脉（ARCA）的异常起源（17 例，48.5%）、左回旋支冠状动脉（9 例，25.7%）、左前降支和左回旋支有单独起源（4 例，11.4%）、左前降支的异常起源（2 例，5.7%）、双重左前降支（2 例，5.7%）和编织状冠状动脉 1（2 例，2.8%）。两组的日本 CTO 评分相似（2.17±1.32 vs 2.38±1.26，p=0.30）。ACA 患者的靶 CTO 更可能具有中度/重度迂曲（44%对 28%，p=0.035），更常需要逆行方法（27%对 12%，p=0.028），并与更长的手术时间（142.5 分钟对 112.00 分钟[74.0，164.0]，p=0.028）和透视时间（56 分钟[40，79 分钟]对 42 分钟[25，67 分钟]，p=0.014）和更高的对比剂用量（260 毫升[190，450]对 200 毫升[150，300]，p=0.004）有关，但手术成功率（91.4%对 85.6%，p=0.46）和技术成功率（91.4%对 87.0%，p=0.59）相似。ACA 患者无主要不良心脏事件（MACE）（0%[0]对非 ACA CTO PCI 的 1.9%[281]，p=1.00）。在 ACA CTO PCI 中报告了 2 例冠状动脉穿孔（p=0.7 vs. 非 ACA CTO PCI）。
结论
ACA 中的 CTO PCI 占 PROGRESS CTO 登记处所有 CTO PCI 的 0.24%，与非 ACA CTO PCI 相比，其手术复杂性更高，但技术和手术成功率相似，MACE 相似。
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