Impacto na via de acesso arterial na abordagem das oclusões totais crônicas coronarianas: uma análise do latam-cto (registro de oclusões totais crônicas na Amérca Latina)
Impacto na via de acesso arterial na abordagem das oclusões totais crônicas coronarianas: uma análise do latam-cto (registro de oclusões totais crônicas na Amérca Latina)
Data
2024
Autores
Côrtes, Leandro Assumpção
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: As intervenções coronárias percutâneas (ICPs) se tornaram a modalidade mais frequente de revascularização miocárdica, porém as oclusões totais crônicas (OTCs) ainda são um desafio, devido â sua maior complexidade. Nas últimas duas décadas uma série de estratégias e de materiais dedicados à ICP de OTCs foram desenvolvidos aumentando a taxa de sucesso na abordagem dessas lesões. A escolha da via de acesso arterial é fundamental nas ICPs, sabendo-se que de um modo geral o acesso radial (AR) está associado a menores taxas de sangramento e até de mortalidade, comparados ao acesso femoral (AF). Porém a utilização do AR nas ICPs de OTCs ainda é controversa e há poucos dados sobre seu uso principalmente na América Latina.
Objetivo: Comparar os resultados intra-hospitalares do AR nas ICPs de OTCs com os do AF a partir dos dados de um grande registro internacional multicêntrico da América Latina de OTCs, o LATAM CTO Registry
Métodos: No período de janeiro de 2018 a abril de 2022 foram avaliados, retrospectivamente, os resultados intra-hospitalares das ICPs de OTCs realizadas por AR exclusivo, em comparação com o AF, observando-se as diferenças entre os dois grupos quanto às variáveis clínicas, angiográficas, variáveis do procedimento, complicações e desfechos clínicos. Os preditores de insucesso do procedimento foram avaliados através de análise por regressão logística multivariada.
Resultados: No período avaliado foram realizados um total de 3136 ICPs em OTCs, sendo o AR exclusivo utilizado em 31,2% das ICPs. No grupo do AR as OTCs eram menos complexas, conforme estratificação pelo escore Japanese-CTO, com menor uso das técnicas de dissecção e reentrada e da técnica retrógrada. Após os ajustes através de regressão logística multivariada não se observaram diferenças na taxa de sucesso do procedimento entre os grupos do AR e do AF (OR: 0,818, 95% IC: 0,587 – 1,139; p = 0,234), assim como eventos cardíacos adversos maiores similares nos dois grupos, porém com um menor número de sangramentos menores no grupo do AR (0,6% x 2,0%, p = 0,018). Os principais preditores para o insucesso do procedimento foram a complexidade da lesão (capa proximal romba, extensão da lesão e calcificações) e o uso da técnica retrógrada.
Conclusão: O AR exclusivo para a ICP de OTCs foi utilizado em aproximadamente um terço dos casos, sendo o seu uso eficaz e seguro com uma taxa de sucesso do procedimento e de eventos cardíacos maiores, no seguimento intra-hospitalar, comparáveis as do AF. Foi observado um menor número de sangramentos menores no grupo AR.
Palavras-chave: angioplastia coronária transluminal percutânea, oclusão coronária total crônica, acesso arterial radial.
ABSTRACT Introduction: Percutaneous coronary interventions (PCIs) have become the most frequent modality of myocardial revascularization in recent decades, but chronic total occlusions (CTOs) are still a challenge due to their greater complexity. Over the past two decades, a series of strategies and materials dedicated to PCI of CTOs have been developed, increasing the success rate in managing these lesions. The choice of arterial access route is fundamental in PCIs, knowing that the radial access (RA) is associated with lower rates of bleeding and even mortality in acute cases compared to femoral access (FA). However, the use of AR in CTO PCIs is still controversial and there is little data on its use, especially in Latin America. Objective: This study aims to compare the in-hospital results of RA in CTO PCIs with those of FA based on data from a large international registry of CTOs in Latin America, the LATAM CTO Registry Methods: From January 2018 to April 2022, the in-hospital outcomes of PCIs from CTOs included in the LATAM CTO Registry between procedures performed exclusively by the RA and FA were compared, observing the differences regarding clinical, angiographic, procedure variables, complications and clinical outcomes in the two groups. Results: A total of 3136 PCIs were performed in CTOs, with exclusive RA used in 31.2% of cases. The CTOs in the RA group were less complex, as stratified by the Japanese-CTO score, with less use of dissection and reentry and retrograde techniques. After adjustments through multivariate logistic regression, no differences were observed in the success rate of the procedure between the RA and FA groups (OR: 0.818, 95% CI: 0.587 – 1.139; p = 0.234), as well as major adverse cardiac events, but with a smaller number of minor bleedings in the RA group. The main predictors for procedural failure were the complexity of the lesion (blunt proximal cap, lesion extension and calcifications) and the use of the retrograde technique. Conclusion: Almost one-third of the procedures were realized through RA exclusively for PCI of CTOs, its use was effective and safe with a success rate for the procedure, as well as MACEs similar to FA in in-hospital follow-up. A lower number of minor bleeds was observed in the AR group. Keywords: percutaneous transluminal coronary angioplasty, chronic coronary total occlusion, radial artery access.
ABSTRACT Introduction: Percutaneous coronary interventions (PCIs) have become the most frequent modality of myocardial revascularization in recent decades, but chronic total occlusions (CTOs) are still a challenge due to their greater complexity. Over the past two decades, a series of strategies and materials dedicated to PCI of CTOs have been developed, increasing the success rate in managing these lesions. The choice of arterial access route is fundamental in PCIs, knowing that the radial access (RA) is associated with lower rates of bleeding and even mortality in acute cases compared to femoral access (FA). However, the use of AR in CTO PCIs is still controversial and there is little data on its use, especially in Latin America. Objective: This study aims to compare the in-hospital results of RA in CTO PCIs with those of FA based on data from a large international registry of CTOs in Latin America, the LATAM CTO Registry Methods: From January 2018 to April 2022, the in-hospital outcomes of PCIs from CTOs included in the LATAM CTO Registry between procedures performed exclusively by the RA and FA were compared, observing the differences regarding clinical, angiographic, procedure variables, complications and clinical outcomes in the two groups. Results: A total of 3136 PCIs were performed in CTOs, with exclusive RA used in 31.2% of cases. The CTOs in the RA group were less complex, as stratified by the Japanese-CTO score, with less use of dissection and reentry and retrograde techniques. After adjustments through multivariate logistic regression, no differences were observed in the success rate of the procedure between the RA and FA groups (OR: 0.818, 95% CI: 0.587 – 1.139; p = 0.234), as well as major adverse cardiac events, but with a smaller number of minor bleedings in the RA group. The main predictors for procedural failure were the complexity of the lesion (blunt proximal cap, lesion extension and calcifications) and the use of the retrograde technique. Conclusion: Almost one-third of the procedures were realized through RA exclusively for PCI of CTOs, its use was effective and safe with a success rate for the procedure, as well as MACEs similar to FA in in-hospital follow-up. A lower number of minor bleeds was observed in the AR group. Keywords: percutaneous transluminal coronary angioplasty, chronic coronary total occlusion, radial artery access.
Description
Palavras-chave
angioplastia coronária transluminal percutânea, oclusão coronária total crônica, acesso arterial radial, percutaneous transluminal coronary angioplasty, chronic coronary total occlusion, radial artery access
Citação
Côrtes LA. Impacto na via de acesso arterial na abordagem das oclusões totais crônicas coronarianas: uma análise do latam-cto (registro de oclusões totais crônicas na Amérca Latina). Rio de Janeiro. dissertação [Mestrado Profiossional em Avaliação de Tecnologias em Saúde] Instituto Nacional de Cardiologia - INC; 2024.