Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-11-14 DOI:10.1002/ccd.31289

Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, James W Choi, Sevket Gorgulu, Farouc A Jaffer, Raj Chandwaney, Khaldoon Alaswad, Mir B Basir, Lorenzo Azzalini, Olga C Mastrodemos, Bavana V Rangan, Konstantinos Voudris, Sandeep Jalli, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis

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Abstract

Background: Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study.

Methods: 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.

Results: 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.

Conclusions: 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.

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左主干慢性全闭塞经皮冠状动脉介入治疗的疗效。

背景：对左主干（LM）慢性全闭塞（CTO）的经皮冠状动脉介入治疗（PCI）研究有限：我们比较了2012年至2024年期间在41个美国和非美国中心接受左主干与非左主干CTO PCI的患者的临床和手术特征及结果：在研究期间，14969 名患者接受了 15254 例 CTO PCI，其中 85 例（0.6%）为 LM CTO PCI。LM CTO PCI患者年龄较大，血脂异常和心衰发生率较高，大多数患者（88.8%）曾接受过冠状动脉旁路移植手术（CABG）。他们更有可能患有中度或严重钙化病变（80.7% 对 45.7%，P 结论：LM CTO PCI 在临床上并不常见：LM CTO PCI 并不常见，具有较高的合并症负担和血管造影复杂性，但成功率高，并发症发生率可接受。

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

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.