A Predictive Model For Successful Percutaneous Coronary Intervention In Patients With Chronic Total Occlusion

Objective:To investigate the risk factors of percutaneous coronary intervention(PCI)for chronic total occlusion(CTO)and to establish a model for predicting the failure of CTO-PCI.Methods:A total of 332 patients who underwent CTO-PCI in the Department of Cardiology of the Second Hospital of Hebei Medical University from 2015.03-2020.03 were analyzed retrospectively.The baseline,laboratory examination and coronary angiography results of the patients were collected.Whether the occluded artery completed revascularization or not,the patients were divided into successful group(n=299):defined as the successful reperfusion of occluded vessels and the recovery of TIMI(Thrombolysis in Myocardial Infarction)3 blood flow by branch vessels.And failed group(n=33):defined as obvious branch occlusion or only TIMI1/2 grade blood flow or balloon unable to pass through the occluded segment after reperfusion of the main branch.The primary outcome was the compound end point event of cardiac death and myocardial infarction(MI)within one year.Results:1.Among the CTO-PCI patients enrolled as a whole,the successful rate was 90.06%(299/332),and the failed rate was 9.94%(33/332).Compared with the successful CTO-PCI group,there are statistically significant in smoking,diabetes mellitus,re-try lesion,hemoglobin,platelet count,monocyte/high density lipoprotein and homocysteine in the failed group(P<0.05).2.Multiple logistic regression analysis showed that the independent risk factors of CTO-PCI failure included smoking(OR=3.33[1.36-8.19],P=0.009),diabetes mellitus(OR=3.81[1.60-9.11],P=0.003).platelet count(OR=1.01[1.00-1.02],P=0.046),number of coronary artery lesion(OR=2.12[1.16-3.87],P=0.014),lesion bending>45°(OR=3.26[1.35-7.87],P=0.009),re-try lesion(OR=5.02[1.46-17.28],P=0.011).the risk predictive model is established.This model can predict CTO-PCI failure(AUC=0.804[0.721-0.885],P<0.001).The sensitivity is 0.788 and the specificity is 0.732.3.Kaplan-Meier survival curve showed that the incidence of major compound events in the 30-day outcome,failed group was significantly higher than that in the successful group(6.06%vs 0.67%),but there was not statistically significant(P=0.051).The incidence of major compound events in the failed group was significantly higher than that in the successful group(37.50%vs 4.87%)in the 12-months outcome,and there was statistically significant(P<0.001).4.Through multivariate cox regression analysis,it was found that platelet count(≥233.50 vs<233.50×10~9/L)[HR=3.48[1.57-7.72],P=0.002],MHR(≥0.7350 vs<0.7350)[HR=3.67[1.65-8.14],P=0.001],lesion length≥20mm(HR=2.72[1.21-6.09],P=0.015)was an independent predictor of compound end point.Conclusions:CTO patients with smoking,diabetes mellitus,increasing platelet count,multi-vessel disease,lesion bending>45°and re-try lesion have a higher risk of failure,so more attention should be paid to such patients in clinic.We establish a predictive model,which has a certain value in predicting the success rate of CTO-PCI.Compared with the successful CTO-PCI,failed CTO-PCI patients were significantly associated with long-term cardiac death and MI.