Background

Predictors of success in reattempted chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures remain obscure, mainly owing to the lack of consecutive angiograms and procedural records of initial attempts in the same cohort.

Objectives

This study sought to investigate the factors predicting the success of reattempted CTO PCI procedures.

Methods

A total of 208 consecutive patients who underwent a failed CTO PCI attempt and received reattempted procedure at the same cardiac center were retrospectively analyzed. Predictors of the success of reattempted procedures were evaluated.

Results

The overall technical success rate of reattempted CTO PCI procedures was 71.2%. Subintimal plaque modification (SPM) was implemented in 35 (16.8%) procedures in initial attempts. The reattempted technical success rate was 93.3% in cases in which SPM with guidewire (GW) crossing was achieved in the initial attempt; however, the success rate was 55.0% for procedures involving SPM without GW crossing. SPM with GW crossing (OR: 11.21; 95% CI: 1.31-96.16; P = 0.028), referral to high-volume operators (OR: 2.38; 95% CI: 1.14-4.98; P = 0.021), and a bidirectional approach (OR: 2.31; 95% CI: 1.12-4.79; P = 0.024) were positive independent predictors of technical success in the subsequent reattempt. The time interval for reattempt (per 90-day increment) was negatively correlated with the technical success of the reattempted procedures (OR: 0.85; 95% CI: 0.73-0.98; P = 0.030).

Conclusions

This study identified independent predictors of success in reattempted CTO PCI procedures. SPM with GW crossing achieved in the initial attempt is associated with a higher success rate in the subsequent reattempt.

中文翻译：

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内膜下斑块修饰对重新尝试慢性完全闭塞经皮冠状动脉介入治疗的影响

背景

再次尝试慢性完全闭塞 (CTO) 经皮冠状动脉介入治疗 (PCI) 手术成功的预测因素仍然不清楚，主要是由于缺乏连续血管造影和同一队列中初次尝试的手术记录。

目标

本研究旨在调查预测再次尝试 CTO PCI 程序成功的因素。

方法

回顾性分析了在同一心脏中心接受 CTO PCI 尝试失败并再次尝试手术的 208 名连续患者。评估了重新尝试手术成功的预测因素。

结果

再次尝试 CTO PCI 程序的总体技术成功率为 71.2%。在最初的尝试中，35 个（16.8%）程序实施了内膜下斑块修饰（SPM）。在初次尝试实现SPM与导丝（GW）交叉的情况下，再尝试技术成功率为93.3％；然而，涉及没有 GW 穿越的 SPM 的程序的成功率为 55.0%。SPM 与 GW 交叉 (OR: 11.21; 95% CI: 1.31-96.16; P  = 0.028)，转介给大容量运营商 (OR: 2.38; 95% CI: 1.14-4.98; P  = 0.021)，以及双向方法（OR：2.31；95% CI：1.12-4.79；P = 0.024）是在随后的重试中技术成功的积极独立预测因素。重试的时间间隔（每 90 天增量）与重试程序的技术成功呈负相关（OR：0.85；95% CI：0.73-0.98；P  = 0.030）。

结论

本研究确定了重新尝试 CTO PCI 程序成功的独立预测因素。在初始尝试中实现 GW 穿越的 SPM 与后续重试中的更高成功率相关。