B-CTO评分应用于冠状动脉慢性完全闭塞病变介入治疗的多中心研究
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摘要
目的:验证在冠状动脉慢性完全闭塞病变(CTO)中B-CTO评分预测介入治疗成功率及难易程度的可行性。方法:根据病变CTO病理解剖学特征对650例CTO患者进行评分,0～3分难度系数定义为"简单",4～6分难度系数定义为"中等",7～9分难度系数定义为"困难",10～12分难度系数定义为"极困难"。观察不同组之间手术成功率,评估B-CTO评分与手术成功和手术时间的关系。结果:B-CTO评分简单组,高达97%的患者通过正向途径取得成功,随着评分难度增加,直接正向夹层再进入技术及逆向技术的使用比例逐渐升高,极困难组逆向比例61%。B-CTO评分预测手术失败的ROC曲线下面积为0.87。结论:B-CTO评分有助于预测CTO手术难易程度,可用做CTO介入治疗术前的评分工具。
Objective:To observe the performance of the buddy-chronic total occlusion(B-CTO) score in predicting success and efficiency of coronary chronic total occlusion(CTO) percutaneous coronary interventions.Method:We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2016 and 2018 at 26 experienced centers in the China.Six hundred and fifty-seven lesions were classified as easy(B-CTO=0-3),intermediate(B-CTO=4-6),difficult(B-CTO=7-9),and very difficult(B-CTO=10-12).The impact of the B-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression,respectively.The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves.Result:Antegrade wiring techniques were used more frequently in easy lesions(97%) than very difficult lesions(58%),whereas the retrograde approach became more frequent with increased lesion difficulty(61% for very difficult lesions).The logistic regression model for technical success demonstrated satisfactory calibration and discrimination(AUC=0.87).Conclusion:B-CTO score was strongly associated with final success and efficiency in this study,supporting its expanded use in CTO interventions.
Objective:To observe the performance of the buddy-chronic total occlusion(B-CTO) score in predicting success and efficiency of coronary chronic total occlusion(CTO) percutaneous coronary interventions.Method:We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2016 and 2018 at 26 experienced centers in the China.Six hundred and fifty-seven lesions were classified as easy(B-CTO=0-3),intermediate(B-CTO=4-6),difficult(B-CTO=7-9),and very difficult(B-CTO=10-12).The impact of the B-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression,respectively.The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves.Result:Antegrade wiring techniques were used more frequently in easy lesions(97%) than very difficult lesions(58%),whereas the retrograde approach became more frequent with increased lesion difficulty(61% for very difficult lesions).The logistic regression model for technical success demonstrated satisfactory calibration and discrimination(AUC=0.87).Conclusion:B-CTO score was strongly associated with final success and efficiency in this study,supporting its expanded use in CTO interventions.
引文
[1] 李晨光,刘学波,葛雷,等.冠状动脉慢性完全闭塞病变介入治疗成功的影响因素探讨[J].中华心血管病杂志,2011,39(1):30-34.
[2] 粟佳男,张丽君,贺毅,等.冠状动脉慢性完全闭塞病变患者侧支循环与存活心肌之间的关系[J].中华心血管病杂志,2017,45(7):579-584.
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[4] 马剑英,郭俊杰,侯磊,等.冠状动脉内旋磨术在慢性完全闭塞病变介入治疗中应用的安全性和有效性[J].中华心血管病杂志,2018,46(4):274-278.
[5] Christopoulos G,Menon RV,Karmpaliotis D,et al.The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions:insights from a contemporary multicenter US registry and comparison with prior studies[J].J Invasive Cardiol,2014,26(9):427-432.
[6] 田乃亮,叶飞,张俊杰,等.冠状动脉造影和血管内超声引导药物洗脱支架植入治疗冠状动脉慢性闭塞病变远期效果的对比研究[J].临床心血管病杂志,2016,32(5):459-463.
[7] Harding SA,Wu EB,Lo S,et al.A new algorithm for crossing chronic total occlusions form the asia pacific chronic total occlusion club[J].JACC Cardiovasc Interv,2017,10(21):2135-2143.
[8] 中国冠状动脉慢性闭塞病变介入治疗俱乐部.中国冠状动脉慢性完全闭塞病变介入治疗推荐路径[J].中国介入心脏病学杂志,2018,26(3):121-128.
[9] Yamamoto E,Natsuaki M,Morimoto T,et al.Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2)[J].Am J Cardiol,2013,112(6):767-774.
[10] El Sabbagh A,Patel VG,Jeroudi OM,et al.Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions:a weighted meta-analysis of 3,482 patients from 26 studies[J].Int J Cardiol,2014,174(2):243-248.
[11] Mehran R,Claessen BE,Godino C,et al.Multinational Chronic Total Occlusion Registry.Long-term outcome of percutaneous coronary intervention for chronic total occlusions[J].JACC Cardiovasc Interv,2011,4(9):952-961.
[12] 郭鹏,刘日辉,栾波,等.逆向开通冠状动脉慢性完全性闭塞病变中预塑型导丝的应用[J].临床心血管病杂志,2016,32(3):268-271.
[13] Patel VG,Brayton KM,Tamayo A,et al.Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions:a weighted meta-analysis of 18,061 patients from 65 studies[J].JACC Cardiovasc Interv,2013,6(2):128-136.
[14] Karmpaliotis D,Lembo N,Kalynych A,et al.Development of a high-volume,multiple-operator program for percutaneous chronic total coronary occlusion revascularization:procedural,clinical,and cost-utilization outcomes[J].Catheter Cardiovasc Interv,2013,82(1):1-8.
[15] MorinoY,Abe M,MorimotoT,et al.J-CTO Registry Investigators.Predicting successful guidewire crossing through chronic total occlusion of native coro-nary lesions within 30 minutes:The J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool[J].JACC Cardiovasc Interv,2011,4(2):213-221.
[16] Christopoulos G,Kandzari DE,Yeh RW,et al.Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions:The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score[J].JACC Cardiovasc Interv.2016,9(1):1-9.
[17] Alessandrino G,Chevalier B,Lefèvre T,et al.A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion[J].JACC Cardiovasc Interv,2015,8(12):1540-1548.
[18] Claessen BE,van der Schaaf RJ,Verouden NJ,et al.Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention[J].JACC Cardiovasc Interv,2009,2(11):1128-1134.
[19] 董加建,梁占涛,毛幼林.冠状动脉慢性完全闭塞病变PCI后支架内再狭窄的预测因素分析[J].临床心血管病杂志,2018,34(11):1104-1106.
[20] 吴开泽,林敬业,张斌,等.经皮冠状动脉介入治疗对慢性完全闭塞病变患者预后的影响[J].岭南心血管病杂志,2019,25(1):1-8.
[21] 单守杰,张俊杰,刘志忠,等.血管内超声指导慢性完全闭塞冠状动脉病变介入治疗[J].临床心血管病杂志,2013,29(12):904-906.
[22] Nombela-Franco L,Urena M,Jerez-Valero M,et al.Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort[J].Circ Cardiovasc Interv,2013,6(6):635-643.
[2] 粟佳男,张丽君,贺毅,等.冠状动脉慢性完全闭塞病变患者侧支循环与存活心肌之间的关系[J].中华心血管病杂志,2017,45(7):579-584.
[3] Brilakis ES,Grantham JA,Rinfret S,et al.A percutaneous treatment algorithm for crossing coronary chronic total occlusions[J].JACC Cardiovasc Interv,2012,5(4):367-379.
[4] 马剑英,郭俊杰,侯磊,等.冠状动脉内旋磨术在慢性完全闭塞病变介入治疗中应用的安全性和有效性[J].中华心血管病杂志,2018,46(4):274-278.
[5] Christopoulos G,Menon RV,Karmpaliotis D,et al.The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions:insights from a contemporary multicenter US registry and comparison with prior studies[J].J Invasive Cardiol,2014,26(9):427-432.
[6] 田乃亮,叶飞,张俊杰,等.冠状动脉造影和血管内超声引导药物洗脱支架植入治疗冠状动脉慢性闭塞病变远期效果的对比研究[J].临床心血管病杂志,2016,32(5):459-463.
[7] Harding SA,Wu EB,Lo S,et al.A new algorithm for crossing chronic total occlusions form the asia pacific chronic total occlusion club[J].JACC Cardiovasc Interv,2017,10(21):2135-2143.
[8] 中国冠状动脉慢性闭塞病变介入治疗俱乐部.中国冠状动脉慢性完全闭塞病变介入治疗推荐路径[J].中国介入心脏病学杂志,2018,26(3):121-128.
[9] Yamamoto E,Natsuaki M,Morimoto T,et al.Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2)[J].Am J Cardiol,2013,112(6):767-774.
[10] El Sabbagh A,Patel VG,Jeroudi OM,et al.Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions:a weighted meta-analysis of 3,482 patients from 26 studies[J].Int J Cardiol,2014,174(2):243-248.
[11] Mehran R,Claessen BE,Godino C,et al.Multinational Chronic Total Occlusion Registry.Long-term outcome of percutaneous coronary intervention for chronic total occlusions[J].JACC Cardiovasc Interv,2011,4(9):952-961.
[12] 郭鹏,刘日辉,栾波,等.逆向开通冠状动脉慢性完全性闭塞病变中预塑型导丝的应用[J].临床心血管病杂志,2016,32(3):268-271.
[13] Patel VG,Brayton KM,Tamayo A,et al.Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions:a weighted meta-analysis of 18,061 patients from 65 studies[J].JACC Cardiovasc Interv,2013,6(2):128-136.
[14] Karmpaliotis D,Lembo N,Kalynych A,et al.Development of a high-volume,multiple-operator program for percutaneous chronic total coronary occlusion revascularization:procedural,clinical,and cost-utilization outcomes[J].Catheter Cardiovasc Interv,2013,82(1):1-8.
[15] MorinoY,Abe M,MorimotoT,et al.J-CTO Registry Investigators.Predicting successful guidewire crossing through chronic total occlusion of native coro-nary lesions within 30 minutes:The J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool[J].JACC Cardiovasc Interv,2011,4(2):213-221.
[16] Christopoulos G,Kandzari DE,Yeh RW,et al.Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions:The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score[J].JACC Cardiovasc Interv.2016,9(1):1-9.
[17] Alessandrino G,Chevalier B,Lefèvre T,et al.A clinical and angiographic scoring system to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion[J].JACC Cardiovasc Interv,2015,8(12):1540-1548.
[18] Claessen BE,van der Schaaf RJ,Verouden NJ,et al.Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention[J].JACC Cardiovasc Interv,2009,2(11):1128-1134.
[19] 董加建,梁占涛,毛幼林.冠状动脉慢性完全闭塞病变PCI后支架内再狭窄的预测因素分析[J].临床心血管病杂志,2018,34(11):1104-1106.
[20] 吴开泽,林敬业,张斌,等.经皮冠状动脉介入治疗对慢性完全闭塞病变患者预后的影响[J].岭南心血管病杂志,2019,25(1):1-8.
[21] 单守杰,张俊杰,刘志忠,等.血管内超声指导慢性完全闭塞冠状动脉病变介入治疗[J].临床心血管病杂志,2013,29(12):904-906.
[22] Nombela-Franco L,Urena M,Jerez-Valero M,et al.Validation of the J-chronic total occlusion score for chronic total occlusion percutaneous coronary intervention in an independent contemporary cohort[J].Circ Cardiovasc Interv,2013,6(6):635-643.