Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis

IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Problems in Cardiology Pub Date : 2024-09-17 DOI:10.1016/j.cpcardiol.2024.102832
Ahmed Abdelaziz MD , Abdelrahman Hafez MD , Karim Atta M.B.B.S , Hanaa Elsayed MD , Ahmed Elaraby MD , Ahmed A. Ibrahim MD , Ahmed Farid Gadelmawla MD , Ahmed Helmi MD , Basel Abdelazeem MD , Carl J. Lavie MD , Jose Tafur-Soto MD
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引用次数: 0

Abstract

Background

Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.

Methods

We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).

Results

A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).

Conclusion

Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.
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经皮冠状动脉介入治疗慢性全闭塞的逆行途径与顺行途径:最新的 Meta 分析。
背景:逆行方法显著提高了慢性全闭塞(CTO)经皮冠状动脉介入治疗(PCI)的成功率。然而,有报道称逆行技术在 CTO PCI 中的手术时间更长,透视和造影剂的使用增加。我们的目的是研究逆行法与顺行法在 CTO PCI 中的院内和长期疗效:我们检索了 PubMed、Scopus、WOS 和 Cochrane Central,截至 2023 年 6 月,纳入了所有比较 CTO PCI 患者逆行入路与顺行入路的相关研究。我们采用随机效应模型对结果数据进行了综合分析,将效应估计值表示为几率比(OR)或平均差(MD),以及相应的95%置信区间(CI):共有18项研究、18830名患者参与了分析。在院内结局方面,逆行入路与较低的 MACE(OR= 0.34,95% CI:0.23 至 0.51)、全因死亡率(OR= 0.35,95% CI:0.19 至 0.64)、MI(OR= 0.36,95% CI:0.25 至 0.53)、紧急心包穿刺术(OR= 0.27,95% CI:0.CIN(OR= 0.46,95% CI:0.33~0.65)、手术并发症(OR= 0.52,95% CI:0.33~0.83)、靶血管穿孔(OR= 0.45,95% CI:0.32~0.64):结论:与逆行技术相比,逆行技术与较高的院内和长期不良事件风险相关,最好在较复杂的CTO病变中实施逆行技术。
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来源期刊
Current Problems in Cardiology
Current Problems in Cardiology 医学-心血管系统
CiteScore
4.80
自引率
2.40%
发文量
392
审稿时长
6 days
期刊介绍: Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.
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