背景:慢性完全闭塞(CTO)经皮冠状动脉介入(PCI)的临床和病变特征以及技术存在差异。
方法:我们分析了患者和病变特征,技术,以及在北美(NA)和欧洲合并地区进行的11503个CTO-PCI手术的结果,亚洲,以及2017年至2023年的非洲,如PROGRESS-CTO注册表中所述。
结果:在NA中进行了八千四百七十九(74%)的手术。与非NA患者相比,NA患者年龄较大,体重指数较高,糖尿病患病率较高,高血压,血脂异常,冠状动脉疾病家族史,既往有PCI、冠状动脉旁路移植术和心力衰竭,脑血管疾病,和外周动脉疾病。他们的CTO更复杂,具有较高的J-CTO(2.56±1.22vs1.81±1.24;P小于.001)和PROGRESS-CTO(1.29±1.01vs1.07±0.95;P小于.001)得分,较长的长度,近端帽模糊的患病率更高,钝/没有树桩,中度至重度钙化,和近端弯曲。逆行(31.0%vs22.1%;P小于.001)和顺行解剖和再入(ADR)(21.2%vs9.2%;P小于.001)在NA中心更常用,以及血管内超声(69.0%vs10.1%;P小于0.001)。NA的手术和透视时间较长,而造影剂体积和辐射剂量较低。在NA和非NA中心中,技术(86.7%vs86.8%;P>.90)和程序(85.4%vs85.8%;P=.70)的成功率和院内主要不良心血管事件(MACE)(1.9%vs1.7%;P=.40)相似。
结论:与非NA患者相比,接受CTOPCI的NA患者有更多的合并症,更高的CTO病变复杂性,更有可能接受逆行和ADR的治疗,并有类似的技术成功和MACE。
BACKGROUND: There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
METHODS: We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.
RESULTS: Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.
CONCLUSIONS: Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.