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Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support / 中华医学杂志(英文版)
Chinese Medical Journal ; (24): 2278-2285, 2009.
Article in English | WPRIM | ID: wpr-307798
ABSTRACT
<p><b>BACKGROUND</b>The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available.</p><p><b>METHODS</b>A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR).</p><p><b>RESULTS</b>The incidence of CTO was 7.9% in patients who underwent PCI. Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32 +/- 22.08) mm vs (27.61 +/- 22.85) mm, P = 0.023), a higher rate of perforation (25.0% vs 0, P = 0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P = 0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P = 0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% CI 0.041-0.612, P = 0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P = 0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P = 0.005), and total stent length (OR 6.02, 95% CI 1.55-11.93, P = 0.027) were three independent predictors of MACE.</p><p><b>CONCLUSIONS</b>PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.</p>
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Full text: Available Index: WPRIM (Western Pacific) Main subject: Therapeutics / Angioplasty, Balloon, Coronary / Coronary Artery Bypass / Chronic Disease / Epidemiology / Survival Rate / Treatment Outcome / Coronary Stenosis Type of study: Prognostic study Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Chinese Medical Journal Year: 2009 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Therapeutics / Angioplasty, Balloon, Coronary / Coronary Artery Bypass / Chronic Disease / Epidemiology / Survival Rate / Treatment Outcome / Coronary Stenosis Type of study: Prognostic study Limits: Adult / Aged / Female / Humans / Male Language: English Journal: Chinese Medical Journal Year: 2009 Type: Article