CBS 2019
CBSMD教育中心
English

科学研究

科研文章

荐读文献

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association A VOYAGER Meta-Analysis of the Impact of Statin Therapy on Low-Density Lipoprotein Cholesterol and Triglyceride Levels in Patients With Hypertriglyceridemia 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery: A Meta-analysis Cardiac Troponin Elevation in Patients Without a Specific Diagnosis A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions Predicting Major Adverse Events in Patients With Acute Myocardial Infarction Cardiac monocytes and macrophages after myocardial infarction Development and validation of a simple risk score to predict 30-day readmission after percutaneous coronary intervention in a cohort of medicare patients

Original Research2018 Oct;11(10):e006436.

JOURNAL:Circ Cardiovasc Interv. Article Link

Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention

Kinnaird T, Gallagher S, British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. Keywords: complications; hospital; mortality; percutaneous coronary intervention

ABSTRACT

BACKGROUND - Enabling strategies (ESs) are increasingly used during percutaneous coronary intervention for chronic total occlusive disease (CTO-PCI), enhancing procedural success. Using the British Cardiovascular Society dataset, we examined changes in the use of ESs and procedural/clinical outcomes for CTO-PCI.

 

METHODS AND RESULTS - ESs were defined as intravascular ultrasound, rotational/laser atherectomy, dual arterial access, use of microcatheters, penetration catheters or CrossBoss, and procedures categorized by number of ESs used. Data were analysed on all elective CTO-PCI procedures performed in England and Wales between 2006 and 2014. Multivariable logistic regression was used to identify predictors of procedural success. During 28 050 CTO-PCIs, there were significant temporal increases in ES use. There was a stepwise increase in CTO success with increased ES use, with 83.8% of cases successful where ≥3 ESs were used. Overall, CTO-PCI success rate for the whole cohort increased from 55.4% in 2006 to 66.9% in 2014 ( P<0.001), but the greatest increase in procedural success was associated with ≥3 ES use. In multivariable analysis, any ES use and the number of ESs used were predictive of procedural success. Coronary perforation increased from 1.2% with zero ES use to 4.0% with ≥3 ( P<0.001). After adjustment, although arterial complication, in-hospital bleeding, in-hospital mortality, and major adverse cardiovascular or cerebrovascular events remained more likely with ES use, 30-day mortality was not significantly different between groups.

 

CONCLUSIONS - ES use during CTO-PCI was associated with significant improvements in CTO-PCI success. ES use was associated with increased procedural complications and in-hospital major adverse cardiovascular events, but not with 30-day mortality.