复合策略在冠状动脉慢性完全闭塞病变介入治疗中的应用结果分析

Analysis of the results of percutaneous coronary intervention performed with the hybrid algorithm in patients with coronary chronic total occlusion

目的观察复合策略在慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI)中的应用结果,评价其有效性和安全性。方法连续纳入2018年1月至2020年12月于中国人民解放军空军军医大学第一附属医院心血管内科接受单名经验丰富术者实施CTO-PCI的患者,收集其临床特征、冠状动脉造影特征、术中结果、院内结局等资料,分析总成功率、不同日本多中心CTO注册研究(J-CTO)评分的治疗结果、复合策略应用结果、失败原因以及院内主要不良心脑血管事件(MACCE)发生率。结果共891例患者接受1010例次CTO-PCI,男性比例87.3%,平均年龄(61±11)岁,平均J-CTO评分为(2.5±1.2)分。总体CTO-PCI成功率为94.8%(957/1010),J-CTO≤1分、=2分、≥3分CTO-PCI的成功率分别为99.5%(205/206)、96.9%(222/229)、92.2%(530/575)。平均使用策略(1.2±0.5)次,首选策略中,正向最为常用(85.0%,858/1010),其次是逆向(13.0%,131/1010)和正向夹层重入(ADR;2.1%,21/1010)。正向、逆向、ADR最终CTO-PCI成功率分别为74.6%(648/869)、83.2%(227/273)、84.5%(82/97),在总成功CTO-PCI中的占比分别为67.7%(648/957)、23.7%(227/957)、8.6%(82/957)。院内MACCE发生率为0.9%(9/1010)。中位导丝操控时间为29(10,60)min,PCI时间为102(69,145)min,X线透视时间为47(34,68)min,对比剂用量为350(270,430)ml,辐射剂量为3.3(2.1,4.8)Gy,空气比释动能-面积乘积为31(21,46)Gy·cm^(2)。结论经验丰富的术者遵循复合策略实施CTO-PCI,可获得很高的成功率及较低的院内MACCE发生率。

Objective We aimed to observe the results of CTO-PCI performed with the hybrid algorithm and evaluate its efficacy and safety.Methods Consecutive patients with CTO lesions who underwent PCI using the hybrid algorithm performed by an experienced operator in the First Affiliated Hospital of PLA Air Force Military Medical University from January 2018 to December 2020 were enrolled.General information about clinical characteristics,coronary angiographic characteristics,procedure results,and in-hospital outcomes was collected.And the success rate,procedural outcomes stratified by J-CTO score grades and strategy,as well as in-hospital MACCE were analyzed.Results A total of 1010 CTO-PCIs were performed in 891 patients,of which 87.3%were men.Mean age was(61±11)years.Mean J-CTO score was(2.5±1.2).Overall success rate was 94.8%(957/1010),which in cases with J-CTO≤1,=2 and≥3 was 99.5%(205/206),96.9%(222/229)and 92.2%(530/575),respectively.An average of(1.2±0.5)strategies were applied per procedure.Antegrade wiring was preferred as the primary strategy in 85.0%(858/1010),followed by retrograde in 13.0%(131/1010)and antegrade dissection and reentry(ADR)in 2.1%(21/1010).The final success rate stratified by antegrade wiring,retrograde and ADR was 74.6%(648/869),83.2%(227/273)and 84.5%(82/97),responding to a proportion of successful cases in 67.7%(648/957),23.7%(227/957)and 8.6%(82/957).In-hospital MACCE occurred in 0.9%(9/1010).Median guidewire manipulation time,PCI time,fluoroscopy time,contrast volume,radiation dose,and air kerma and dose area product were 29(10,60)min,102(69,145)min,47(34,68)min,350(270,430)ml,3.3(2.1,4.8)Gy and 31(21,46)Gy·cm^(2).Conclusions CTO-PCI is performed with high success rates and low in-hospital MACCE by experienced operator using the hybrid algorithm.