Outcomes following antegrade-only versus retrograde chronic total occlusion percutaneous coronary intervention: insights from the CCTOP registry.

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Invasive Cardiology Pub Date : 2024-08-19 DOI:10.25270/jic/24.00130

Louis Verreault-Julien, Israth Jahan, Nandini Dendukuri, Luiz F Ybarra, Samer Mansour, Alexis Matteau, Harindra C Wijeysundera, Anthony Fung, Simon Robinson, Jean-Michel Paradis, Can Manh Nguyen, Stéphane Rinfret

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引用次数: 0

Abstract

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be performed using an antegrade-only (AO) approach or a retrograde approach (RA). Whether an RA carries a higher risk of complications needs further investigation.

Methods: The Canadian CTO PCI (CCTOP) was a multicenter, prospective, investigator-initiated cohort study conducted at 6 experienced centers across Canada between March 2014 and October 2019. Patients who underwent an RA were compared to AO patients. The primary endpoint was in-hospital major adverse cardiac events (MACE), defined as death, any post-PCI cardiac enzyme elevation, urgent revascularization, and tamponade. A multivariable analysis was performed to control for potential confounders.

Results: A total of 1033 patients were included in the study, and an RA was used in 48.4% of the cases. The RA was associated with higher lesions complexity (J-CTO score 2.7 ± 1.1 vs 2.3 ± 1.1, P < .001) and lower technical success (81.2% vs 91.5%, P < .001). The risk of in-hospital MACE was higher with the RA (10.2% vs 4.7%, P < .001), and all deaths occurred in the RA group (0.8% vs 0%, P = .038). In the multivariable model, the RA remained associated with an increased risk of MACE (OR, 2.25; 95% CI, 1.26 to 4.02).

Conclusions: Our experience confirms that the RA is associated with an independent increased risk of in-hospital MACE when compared with an AO approach.

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纯前向与逆行慢性全闭塞经皮冠状动脉介入治疗后的疗效：CCTOP 登记的启示。

背景：慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）可采用纯前向途径（AO）或逆行途径（RA）。RA是否会带来更高的并发症风险需要进一步研究：加拿大 CTO PCI（CCTOP）是一项由研究者发起的多中心、前瞻性队列研究，于 2014 年 3 月至 2019 年 10 月期间在加拿大 6 个经验丰富的中心进行。接受RA的患者与接受AO的患者进行了比较。主要终点是院内主要心脏不良事件（MACE），定义为死亡、PCI后任何心肌酶升高、紧急血管再通术和填塞。为控制潜在的混杂因素，进行了多变量分析：研究共纳入了 1033 例患者，48.4% 的病例使用了 RA。RA与较高的病变复杂性（J-CTO评分为2.7 ± 1.1 vs 2.3 ± 1.1，P < .001）和较低的技术成功率（81.2% vs 91.5%，P < .001）相关。RA组发生院内MACE的风险更高（10.2% vs 4.7%，P < .001），所有死亡病例均发生在RA组（0.8% vs 0%，P = .038）。在多变量模型中，RA 仍与 MACE 风险增加相关（OR，2.25；95% CI，1.26 至 4.02）：我们的经验证实，与AO方法相比，RA与院内MACE风险增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Invasive Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.90

自引率

6.70%

发文量

214

审稿时长

3-8 weeks

期刊介绍： The Journal of Invasive Cardiology will consider for publication suitable articles on topics pertaining to the invasive treatment of patients with cardiovascular disease.