Strepkos Dimitrios, Alexandrou Michaella, Mutlu Deniz, Carvalho Pedro E P, Choi James W, Gorgulu Sevket, Jaffer Farouc A, Chandwaney Raj, Alaswad Khaldoon, Basir Mir B, Azzalini Lorenzo, Mastrodemos Olga C, Rangan Bavana V, Voudris Konstantinos, Jalli Sandeep, Burke M Nicholas, Sandoval Yader, Brilakis Emmanouil S
Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA.
Catheter Cardiovasc Interv. 2025 Jan;105(1):23-31. doi: 10.1002/ccd.31289. Epub 2024 Nov 14.
Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study.
We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024.
During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts.
LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.
经皮冠状动脉介入治疗（PCI）左主干（LM）慢性完全闭塞病变（CTO）的研究有限。
我们比较了2012年至2024年期间在美国和非美国的41个中心接受LM与非LM CTO PCI患者的临床和手术特征及结果。
在研究期间，14969例患者进行的15254例CTO PCI中有85例（0.6%）为LM CTO PCI。LM CTO PCI患者年龄较大，血脂异常和心力衰竭发生率较高，大多数（88.8%）曾接受冠状动脉旁路移植术（CABG）。他们更有可能有中度或重度钙化病变（80.7%对45.7%，p<0.001），且J-CTO评分更高（2.76±1.17对2.37±1.26，p=0.008）、PROGRESS-CTO MACE评分更高（3.56对2.57，p<0.001）、死亡率更高（2.45对1.68，p<0.001）、心包穿刺率更高（2.74对1.87，p<0.001）、急性心肌梗死发生率更高（1.72对0.89，p<0.001）以及穿孔率更高（3.21对2.19，p<0.001）。技术成功率（80.5%对87.2%，p=0.086）或主要心血管不良事件（MACE）发生率（2.4%对2.0%，p=0.700）无差异。有或无既往CABG手术的LM CTO PCI患者技术成功率和MACE相似。既往CABG患者的逆向途径更可能通过大隐静脉移植进行。
LM CTO PCI很少进行，与高合并症负担和血管造影复杂性相关，但可以获得高成功率和可接受的并发症发生率。
