■接受慢性完全闭塞-经皮冠状动脉介入治疗(CTO-PCI)尝试失败的患者代表了所有接受CTO-PCI患者的一个具有挑战性的亚组。关于先前尝试失败对后续CTO-PCI结果的影响的数据有限。我们旨在比较先前尝试CTO-PCI与最初尝试CTO-PCI的手术结果和24个月结局。
■在2017年1月至2019年12月期间尝试CTO-PCI的患者被前瞻性纳入。我们分析了先前尝试失败和初次尝试CTO-PCI的患者之间的手术结果和24个月的主要不良心脏事件(MACE)。MACE被定义为心脏死亡的复合物,靶血管相关心肌梗死,随访期间缺血驱动的靶血管血运重建(TVR)。
■总共,484例接受CTO-PCI的患者(先前尝试失败,n=49;初始尝试,n=435)在研究期间登记。在倾向得分匹配(1:3)后,147例患者被纳入初次尝试组。先前尝试失败的患者的日本CTO(J-CTO)评分≥2的比例高于最初尝试的患者(77.5%vs.38.8%,p<0.001)。与最初尝试组相比,先前尝试失败组采用逆行方法的频率更高(32.7%vs.3.4%,[P<0.001)。成功的CTO血运重建率在先前失败的尝试组中显著低于最初尝试组(53.1%vs.83.3%,P<0.001)。多变量分析显示J-CTO评分≥2[比值比(OR),0.359;95%置信区间(CI),0.159-0.812;P=0.014],血管内超声程序(OR,4.640;95%CI,1.380-15.603;P=0.013),和先前失败的尝试(或,0.285;95%CI,0.125-0.648;P=0.003)是CTO血运重建成功的独立预测因子。主要手术并发症无显著差异(2.0%vs.0.7%,p=0.438)和MACE率(4.1%与8.8%,p=0.438)组间,主要是由于TVR率(4.1%与8.2%,P=0.522)。
■与初次尝试CTO-PCI相比,先前失败的CTO-PCI值得更多关注,因为它与CTO血运重建成功率较低相关。先前失败的尝试,J-CTO评分≥2分,IVUS手术是预测CTO血运重建成功的决定因素。既往尝试失败和初次尝试CTO-PCI的患者之间没有明显不同的不利结果。
UNASSIGNED: Patients undergoing a prior failed attempt of chronic total occlusion-percutaneous coronary intervention (CTO-PCI) represent a challenging subgroup across all patients undergoing CTO-PCI. There are limited data on the effects of a prior failed attempt on the outcomes of subsequent CTO-PCI. We aimed to compare the procedural results and 24-month outcomes of prior-failed-attempt CTO-PCI with those of initial-attempt CTO-PCI.
UNASSIGNED: Patients who underwent attempted CTO-PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 24-month major adverse cardiac events (MACE) between patients who underwent prior-failed-attempt and initial-attempt CTO-PCI. MACE was defined as a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization (TVR) during follow-up.
UNASSIGNED: In total, 484 patients who underwent CTO-PCI (prior-failed-attempt, n = 49; initial-attempt, n = 435) were enrolled during the study period. After propensity score matching (1:3), 147 patients were included in the initial-attempt group. The proportion of the Japanese-CTO (J-CTO) score ≥2 was higher in the patients who underwent prior failed attempt than in those who underwent initial attempt (77.5% vs. 38.8%, p < 0.001). The retrograde approach was more often adopted in the prior-failed-attempt group than in the initial-attempt group (32.7% vs. 3.4%, [P< 0.001). Successful CTO revascularization rates were significantly lower in the prior-failed attempt-group than in the initial attempt group (53.1% vs. 83.3%, P < 0.001). The multivariate analysis revealed that J-CTO score ≥2 [odds ratio (OR), 0.359; 95% confidence interval (CI), 0.159-0.812; P = 0.014], intravascular ultrasound procedure (OR, 4.640; 95% CI, 1.380-15.603; P = 0.013), and prior failed attempt (OR, 0.285; 95% CI, 0.125-0.648; P = 0.003) were the independent predictors for successful CTO revascularization. There were no significant differences in major procedural complications (2.0% vs. 0.7%, p = 0.438) and MACE rates (4.1% vs. 8.8%, p = 0.438) between the groups, mainly due to the TVR rate (4.1% vs. 8.2%, P = 0.522).
UNASSIGNED: Compared with initial-attempt CTO-PCI, prior-failed-attempt CTO-PCI deserves more attention, since it is associated with a lower successful CTO revascularization rate. Prior failed attempt, J-CTO score ≥2, and IVUS procedure are the determining factors for predicting successful CTO revascularization. There are no significantly different unfavorable outcomes between patients who undergo prior-failed-attempt and initial-attempt CTO-PCI.