Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

Dimitrios Strepkos,Michaella Alexandrou，Yader Sandoval,Emmanouil S. Brilakis

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS（2025）

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Abstract

BackgroundPercutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study. MethodsWe compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024. ResultsDuring the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 +/- 1.17 vs. 2.37 +/- 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts. ConclusionsLM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.

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Key words

chronic total occlusion,coronary artery bypass graft,left main,percutaneous coronary intervention

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【要点】：研究比较了左主冠状动脉慢性完全闭塞（LM CTO）和非LM CTO经皮冠状动脉介入（PCI）的临床和 procedural 特征及结果，发现LM CTO PCI尽管并发症风险较高，但成功率较高且并发症率可接受。

【方法】：通过回顾性分析2012年至2024年间在美国及非美国41个中心进行的15,254例CTO PCI手术，比较了LM CTO与非LM CTO患者的临床和 procedural 特征及结果。

【实验】：研究期间共进行了14,969名患者的85例LM CTO PCI手术（占比0.6%），结果显示LM CTO PCI患者年龄较大，合并症较多，如血脂异常和心衰比例高，且多数（88.8%）有冠状动脉旁路移植手术史；LM CTO PCI患者病变钙化程度更高，技术成功率和非重大心血管不良事件（MACE）发生率与非LM CTO患者相似。