背景:顺行布线是最常用的慢性完全闭塞(CTO)交叉技术。
方法:使用来自PROGRESSCTO注册中心的数据(慢性完全闭塞干预研究的前瞻性全球注册中心;Clinicaltrials.gov标识符:NCT02061436),我们检查了使用主要顺行布线策略进行CTO经皮冠状动脉介入治疗(PCI)的临床和血管造影特征以及手术结局.
结果:在2012年至2023年之间在46个中心进行的13563个CTOPCI中,在11332个(83.6%)中使用了一次顺行布线策略。通过多变量逻辑回归分析,近端上限歧义(比值比[OR]:0.52;95%CI,0.46-0.59),近端帽侧支(OR:0.85;95%CI,0.77-0.95),钝/无残端(OR:0.52;95%CI:0.47-0.59),病变长度增加(OR[每10毫米增加]:0.79;95%CI,0.76-0.81),中度至重度钙化(OR:0.73;95%CI,0.66-0.81),中度至重度近端弯曲(OR:0.67;95%CI,0.59-0.75),远端帽分叉(OR:0.66;95%CI,0.59-0.73),左前降支CTO(OR[vs右冠状动脉]:1.44;95%CI,1.28-1.62)和左回旋支CTO(OR[vs右冠状动脉]:1.22;95%CI,1.07-1.40),非支架内再狭窄病变(OR:0.56;95%CI,0.49-0.65),良好的远端着陆区(OR:1.18;95%CI,1.06-1.32)与主要顺行线路穿越成功独立相关。
结论:在我们的注册中,使用顺行布线作为初始策略的比例很高(83.6%)。我们确定了与主要顺行布线成功相关的几个参数。
BACKGROUND: Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique.
METHODS: Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy.
RESULTS: Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR]: 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR: 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR: 0.52; 95% CI: 0.47-0.59), increasing lesion length (OR [per 10 mm increase]: 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR: 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR: 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR: 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery]: 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery]: 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR: 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR: 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success.
CONCLUSIONS: The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.