BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
冠状动脉慢性完全闭塞(Chronic Total Occlusion,CTO)病变是目前冠状动脉疾病介入领域的重点和难点,也是冠状动脉粥样硬化性心脏病(冠心病)介入治疗领域需要攻克的“堡垒”[1]。临床研究证明,CTO病变占全部心脏介入治疗患者的10%~20%,...冠状动脉慢性完全闭塞(Chronic Total Occlusion,CTO)病变是目前冠状动脉疾病介入领域的重点和难点,也是冠状动脉粥样硬化性心脏病(冠心病)介入治疗领域需要攻克的“堡垒”[1]。临床研究证明,CTO病变占全部心脏介入治疗患者的10%~20%,但接受介入治疗再血管化治疗的患者不足8%[2]。出现心脏血管慢性完全闭塞的冠心病患者应尽早接受治疗,及时开通闭塞血管,以降低心力衰竭或心肌梗死后猝死的发病率。本文就目前CTO血运重建的介入治疗策略以及临床获益进行综述。展开更多
冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）是指冠状动脉粥样硬化病变严重,冠状动脉内斑块负荷重,导致冠状动脉完全或几乎完全闭塞的病变。冠状动脉闭塞的时间通常难以确定,但CTO病变一般是指冠状动脉闭塞至少3个月以上...冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）是指冠状动脉粥样硬化病变严重,冠状动脉内斑块负荷重,导致冠状动脉完全或几乎完全闭塞的病变。冠状动脉闭塞的时间通常难以确定,但CTO病变一般是指冠状动脉闭塞至少3个月以上的病变[1]。展开更多
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
文摘冠状动脉慢性完全闭塞(Chronic Total Occlusion,CTO)病变是目前冠状动脉疾病介入领域的重点和难点,也是冠状动脉粥样硬化性心脏病(冠心病)介入治疗领域需要攻克的“堡垒”[1]。临床研究证明,CTO病变占全部心脏介入治疗患者的10%~20%,但接受介入治疗再血管化治疗的患者不足8%[2]。出现心脏血管慢性完全闭塞的冠心病患者应尽早接受治疗,及时开通闭塞血管,以降低心力衰竭或心肌梗死后猝死的发病率。本文就目前CTO血运重建的介入治疗策略以及临床获益进行综述。
