Han Feihuang, Ma Dunliang, Wen Song, Wan Qiheng, Huang Yuqing, Wang Feng, Huang Zehan, Zhang Bin
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People's Republic of China.
Am J Cardiovasc Drugs. 2025 Jul 12. doi: 10.1007/s40256-025-00750-z.
Chronic total occlusion (CTO) affects 15-25% of patients undergoing coronary angiography, and successful percutaneous coronary intervention (PCI) can improve ischemia, angina symptoms, and overall quality of life. However, CTO-PCI is a complex procedure with higher risks of acute thrombosis, restenosis, and long-term thrombosis due to factors such as longer lesion length, calcification, and the need for more stents. Dual antiplatelet therapy (DAPT) is essential after PCI, but the optimal regimen for CTO, particularly in patients with chronic coronary syndrome, remains under debate. Although more potent P2Y12 inhibitors such as ticagrelor may offer benefits in some cases, recent studies have shown mixed results.
This study aimed to assess the effect of potent DAPT on long-term outcomes in patients with CTO undergoing retrograde PCI.
We conducted a retrospective analysis of 836 consecutive patients who underwent elective retrograde CTO-PCI at a single center between January 2011 and April 2023. We compared patient and lesion characteristics, procedural details and results, and long-term outcomes between patients who received ticagrelor and those who received clopidogrel after retrograde CTO-PCI.
Clinical follow-up was available in 767 (91.2%) patients, with a median follow-up of 1041 days (range 531-1511). The risk of major adverse cardiovascular events was significantly lower in patients receiving ticagrelor than in those receiving clopidogrel (8.8% vs. 18.5%, p = 0.005), primarily due to reductions in all-cause mortality (1.9% vs. 8.1%, p = 0.009) and cardiac death (0.6% vs. 5.8%, p = 0.012).
DAPT with ticagrelor may represent a safe and efficient management strategy for patients undergoing retrograde CTO-PCI.
慢性完全闭塞（CTO）影响15%-25%接受冠状动脉造影的患者，成功的经皮冠状动脉介入治疗（PCI）可改善缺血、心绞痛症状及总体生活质量。然而，CTO-PCI是一项复杂的手术，由于病变长度较长、钙化以及需要更多支架等因素，急性血栓形成、再狭窄和长期血栓形成的风险更高。PCI术后双重抗血小板治疗（DAPT）至关重要，但CTO的最佳治疗方案，尤其是慢性冠状动脉综合征患者的最佳方案，仍存在争议。尽管更有效的P2Y12抑制剂如替格瑞洛在某些情况下可能有益，但最近的研究结果不一。
本研究旨在评估强效DAPT对接受逆向PCI的CTO患者长期预后的影响。
我们对2011年1月至2023年4月在单一中心接受择期逆向CTO-PCI的836例连续患者进行了回顾性分析。我们比较了接受替格瑞洛和接受氯吡格雷的患者在逆向CTO-PCI术后的患者和病变特征、手术细节和结果以及长期预后。
767例（91.2%）患者有临床随访资料，中位随访时间为1041天（范围531-1511天）。接受替格瑞洛的患者发生主要不良心血管事件的风险显著低于接受氯吡格雷的患者（8.8%对18.5%，p=0.005），主要是由于全因死亡率降低（1.9%对8.1%，p=0.009）和心源性死亡降低（0.6%对5.8%，p=0.012）。
替格瑞洛进行DAPT可能是接受逆向CTO-PCI患者的一种安全有效的管理策略。
