Long-term outcome between two different revascularization strategies for patients with left main coronary artery disease and concomitant chronic total occlusion of right coronary artery disease.

IF 2.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2026-09-09 DOI:10.1097/MCA.0000000000001670

Chuan-Tsai Tsai, Wei-Chieh Huang, Shao-Sung Huang, Yi-Lin Tsai, Tse-Min Lu

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引用次数: 0

Abstract

Objectives: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease is technically demanding if there is a concomitant chronic total occlusion (CTO) of the right coronary artery (RCA). Which vessel to be revascularized in first attempt was not evaluated before.

Methods: We included 32 845 patients who received coronary angiography in Taipei Veterans General Hospital between January 2011 and December 2020. A total of 135 patients had both LMCA disease and RCA CTO. We compared two revascularization strategies of recanalization: one that revascularized the RCA CTO first and one that received LMCA PCI first.

Results: A total of 107 patients received revascularization of the LMCA first, and 28 patients received RCA CTO PCI first. There was no difference in periprocedural (cardiogenic shock and cardiac tamponade) (18 vs. 20%; P = 1.000 and 0 vs. 2%; P = 1.000, respectively) and in-hospital complications (acute kidney injury, acute respiratory failure, and in-hospital mortality) (7 vs. 7%; P = 1.000, 0 vs. 6%; P = 0.343, and 7 vs. 7%; P = 1.000, respectively). Three-year major adverse cardiocerebrovascular event (MACE) was not statistically different between the two groups (18 vs. 25%; P = 0.197). Three-year MACE was statistically significantly lower in the complete revascularization group (both LMCA PCI and successful RCA CTO PCI) than in the partial revascularization group (LMCA PCI only) (16 vs. 28%; P = 0.017).

Conclusion: In patients with LMCA disease and concomitant RCA CTO, LMCA PCI did not differ from RCA CTO PCI in the first attempt in terms of periprocedural, in-hospital, 3-year all-cause mortality, and 3-year MACE.

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左主干冠状动脉病变合并慢性右冠状动脉全闭塞患者两种不同血运重建术的远期疗效

目的：如果伴有右冠状动脉（RCA）慢性全闭塞（CTO），经皮冠状动脉介入治疗（PCI）在技术上是有要求的。哪条血管在第一次尝试时进行血运重建之前没有评估过。方法：纳入2011年1月至2020年12月在台北退伍军人总医院接受冠状动脉造影的32 845例患者。共有135例患者同时患有LMCA疾病和RCA CTO。我们比较了两种再通的血运重建策略：一种是首先对RCA CTO进行血运重建，另一种是首先接受LMCA PCI。结果：107例患者先行LMCA血运重建术，28例患者先行RCA CTO PCI。围手术期（心源性休克和心包填塞）（18% vs 20%; P = 1.000和0 vs. 2%; P = 1.000）和院内并发症（急性肾损伤、急性呼吸衰竭和院内死亡率）（7 vs. 7%; P = 1.000, 0 vs. 6%; P = 0.343和7 vs. 7%; P = 1.000）无差异。两组3年主要不良心脑血管事件（MACE）发生率无统计学差异（18% vs. 25%; P = 0.197）。完全血运重建术组（LMCA PCI和成功的RCA CTO PCI）的3年MACE显著低于部分血运重建术组（仅LMCA PCI）（16% vs. 28%; P = 0.017）。结论：在LMCA疾病并伴有RCA CTO的患者中，LMCA PCI与RCA CTO PCI在围手术期、院内、3年全因死亡率和3年MACE方面的首次尝试没有差异。

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

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.