慢性完全闭塞病变行经皮冠状动脉介入治疗结局影响因素分析及对临床-病变相关评分预测价值的评价

目的探索影响慢性完全闭塞(CTO)病变行经皮冠状动脉介入治疗(PCI)结局的患者临床特点与冠状动脉造影(CAG)图像特征,对比日本多中心CTO注册中心(J-CTO)评分、临床-病变相关(CL)评分对PCI结局的预测价值。方法纳入2019年1月1日至2019年6月30日于首都医科大学附属北京安贞医院行CAG检查确诊CTO病变并尝试进行PCI的157例患者共162处病变。根据病变行PCI是否全部成功分为PCI成功患者组(121例)以及PCI失败患者组(36例),根据病变最终是否成功开通分为PCI成功组(125处)以及PCI失败组(37处)。收集患者临床及CAG病变特征资料,分析影响CTO-PCI成功的因素,采用CL评分及J-CTO评分分别对病变进行评价,比较预测价值差异。结果157例患者中男性130例(82.8%),平均年龄(60.0±9.7)岁,最终PCI成功开通CTO病变125处(77.2%)。PCI失败患者组既往CTO病变PCI失败(33.3%比16.5%,P=0.028)、既往PCI(47.2%比28.1%,P=0.035)比例显著大于PCI成功患者组,差异均有统计学意义。PCI失败组近端钝形纤维帽(56.8%比32.0%,P=0.006)、病变长度≥20 mm(67.6%比22.4%,P<0.001)、病变迂曲>45°(45.9%比16.0%,P<0.001)以及侧支循环Rentrop 0~1级比例(27.0%比9.6%,P=0.007),J-CTO评分(2.24±1.01)分比(1.05±0.94)分,P<0.001]、CL评分(3.01±1.22)分比(1.80±1.26)分,P<0.001]均高于PCI成功组,差异均有统计学意义。logistic多因素回归分析显示,病变长度≥20 mm(OR 0.216,95%CI 0.082~0.569,P=0.002)、近端钝形纤维帽(OR 0.232,95%CI 0.091~0.590,P=0.002)以及侧支循环Rentrop 0~1级(OR 0.299,95%CI 0.094~0.949,P=0.040)为PCI成功开通CTO病变的独立危险因素。CL评分及J-CTO评分预测PCI结局的受试者工作特征曲线下面积分别为0.749(95%CI 0.675~0.814)和0.794(95%CI 0.723~0.853),两者比较差异无统计学意义(P=0.260)。结论病变长度≥20 mm、近端钝形纤维帽以及侧支循环Rentrop 0~1级为PCI成功开通CTO病变的独立危险因素。在预测CTO-PCI结局方面,CL评分与J-CTO评分预测价值相当。

Predictors of successful percutaneous coronary intervention for chronic total occlusion patients and predictive performance evaluation of clinical and lesion-related score

Objective To explore the clinical and angiographic characteristics associated with percutaneous coronary intervention(PCI)outcome in chronic total occlusion(CTO)patients and evaluate the prediction performance of CL score compared with J-CTO score.Methods A total of 157 consecutive patients with 162 CAG confi rmed CTO lesions were retrospectively enrolled from January 1,2019 to June 30,2019 in our hospital.Enrolled patients were divided into 2 groups according to whether had at least one failed CTO-PCI(121 patients vs.36 patients)and lesions were compared between groups according to whether reached procedure success(125 lesions vs.37 lesions).Clinical and angiographic features were collected and compared between procedure success and failure groups.J-CTO score and CL score were calculated and ROC curves were used to compare the predictive value of 2 scoring systems.Results Among 157 enrolled patients,there were 130 males(82.8%),the mean age was(60.0±9.7)years,and 77.2%(n=125)lesions reached procedure success.For patients with at least 1 failed CTO-PCI,there were more prior failed attempt(33.3%vs.16.5%,P=0.028)and prior PCI(48.6%vs.29.3%,P=0.035)than the patients with successful CTO-PCI signifi cantly.CTO lesions with procedure failure showed more proximal blunt stump(56.8%vs.32.0%,P=0.006),occlusion length≥20 mm(67.6%vs.22.4%,P<0.001),bending>45°(45.9%vs.16.0%,P<0.001),Rentrop class 0–1 collaterals(27.0%vs.9.6%,P=0.007),higher J-CTO score(2.24±1.01)points vs.(1.05±0.94)points,P<0.001]and CL score(3.01±1.22)points vs.(1.80±1.26)points,P<0.001]than success group.After multivariate logistic regression analysis,occlusion length≥20 mm(OR 0.216,95%CI 0.082–0.569,P=0.002),proximal blunt stump(OR 0.232,95%CI 0.091–0.590,P=0.002)and Rentrop class 0–1 collaterals(OR 0.299,95%CI 0.094–0.949,P=0.040)were independent predictors of procedure success.The ROC curve of J-CTO and CL score were not diff erent signifi cantly(0.794,95%CI 0.675–0.814 vs.0.749,95%CI 0.723–0.853,P=0.260).Conclusions Occlusion length≥20 mm,proximal blunt stump and Rentrop class 0–1 collaterals were independent predictors of CTO-PCI failure.Predictive value of CL score was comparable with J-CTO.