Chronic total occlusion percutaneous coronary intervention of anomalous coronary arteries: insights from the PROGRESS CTO registry

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-10-04 DOI:10.1002/ccd.31248

Gustavo M. Hirata MD, Athanasios Rempakos MD, A. Walker Boyd MD, Michaella Alexandrou MD, Deniz Mutlu MD, James W. Choi MD, Paul Poommipanit MD, Jaikirshan J. Khatri MD, Laura Young MD, Rhian Davies DO, MS, Sevket Gorgulu MD, Farouc A. Jaffer MD, PhD, Raj Chandwaney MD, Brian Jefferson MD, Basem Elbarouni MD, Lorenzo Azzalini MD, PhD, MSc, Kathleen E. Kearney MD, Khaldoon Alaswad MD, Mir B. Basir DO, Oleg Krestyaninov MD, Dmitrii Khelimskii MD, Nazif Aygul MD, Nidal Abi-Rafeh MD, Ahmed ElGuindy MD, Omer Goktekin MD, Bavana V. Rangan BDS, MPH, Olga C. Mastrodemos BA, Ahmed Al-Ogaili MD, Yader Sandoval MD, M. Nicholas Burke MD, Emmanouil S. Brilakis MD, Jarrod D. Frizzell MD

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引用次数: 0

Abstract

Background

There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).

Methods

We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.

Results

Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI).

Conclusions

CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.

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异常冠状动脉的慢性全闭塞经皮冠状动脉介入治疗：PROGRESS CTO 登记的启示。

背景：有关异常冠状动脉（ACA）慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的频率和结果的信息有限：有关异常冠状动脉（ACA）慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的频率和结果的信息非常有限：我们研究了2012年至2023年期间在46个美国和非美国中心接受14,173例CTO PCI的14,470名患者的临床和血管造影特征以及ACA CTO PCI的手术结果：在 14,470 例 CTO PCI 中，有 36 例（0.24%）是在 ACA 中进行的 CTO PCI。ACA患者的基线特征与非ACA患者相似。发现 CTO 病变的 ACA 类型如下：右冠状动脉异常起源 (ARCA)（17 例，占 48.5%）、左侧环状冠状动脉异常起源（9 例，占 25.7%）、左前降支动脉和左侧冠状动脉起源不同（4，11.4%）、左前降支动脉起源异常（2，5.7%）、双左前降支动脉（2，5.7%）和编织冠状动脉 1（2.8%）。两组患者的日本 CTO 评分相似（2.17 ± 1.32 vs 2.38 ± 1.26，P = 0.30）。ACA患者的目标CTO更可能有中度/重度迂曲（44% vs 28%，P = 0.035），更经常需要使用逆行入路（27% vs 12%，P = 0.028），手术时间更长（142.5 min vs 112.00 min [74.0, 164.0]，P = 0.028）和透视（56 分钟 [40, 79 毫升] vs 42 分钟 [25, 67]，p = 0.014）时间，以及更高的造影剂用量（260 毫升 [190, 450] vs 200 毫升 [150, 300]，p = 0.004），但手术成功率（91.4% vs 85.6%，p = 0.46）和技术成功率（91.4% vs 87.0%，p = 0.59）相似。ACA患者未发生重大心脏不良事件（MACE）（0% [0] vs 1.9% [281] 非ACA患者，p = 1.00）。ACA CTO PCI中报告了两例冠状动脉穿孔（与非ACA CTO PCI相比，p = 0.7）：在 PROGRESS CTO 注册中心进行的所有 CTO PCI 中，ACA CTO PCI 占 0.24%，与非 ACA CTO PCI 相比，ACA CTO PCI 的手术复杂性更高，但技术和手术成功率相似，MACE 相似。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.