成功开通冠状动脉慢性完全闭塞病变的冠状动脉造影影像学影响因素的Meta分析  

The angiographic predictors of successful chronic total occlusion percutaneous coronary intervention:a meta-analysis

作　　者：梁士楚 白彦琳 张静[1] 刁凯悦 李静[4] 马敏[1] 黄鹤[1] 贺勇[1] LIANG Shichu;BAI Yanlin;ZHANG Jing;DIAO Kaiyue;LI Jing;MA Min;HUANG He;HE Yong(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Research Center of Evidence-Based Medicine and Clinical Epidemiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院心脏内科,成都610041 [2]四川大学华西医院/华西临床医学院,成都610041 [3]四川大学华西医院放射科,成都610041 [4]四川大学华西医院循证医学与临床流行病学研究中心,成都610041

出　　处：《中国循证医学杂志》2023年第8期908-915,共8页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:82200553);中国博士后科学基金第68批面上资助(编号:2020M683325);四川省科技计划项目(编号:2022YFS0357、2023YFG0276);四川大学华西医院专职博士后研发基金(编号:2020HXBH048);2020年四川省医学(青年创新)科研课题(编号:Q20061)。

摘　　要：目的系统评价成功开通冠状动脉慢性完全闭塞(CTO)病变的冠状动脉造影影像学影响因素。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CBM、WanFang Data和CNKI数据库,搜集CTO经皮冠状动脉介入治疗(PCI)相关的观察性研究,检索时限均从建库至2022年12月18日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入36个研究。Meta分析结果表明:影响CTO-PCI成功的冠状动脉造影影像学因素包括钙化[OR=1.92,95%CI(1.49,2.47),P<0.01]、闭塞长度≥20 mm[OR=1.80,95%CI(1.26,2.57),P<0.01]、钝性头端[OR=1.53,95%CI(1.08,2.16),P<0.01]、病变迂曲>45°[OR=2.19,95%CI(1.56,3.08),P<0.01]、开口处病变[OR=2.27,95%CI(1.34,3.85),P<0.01]、近端纤维帽模糊[OR=2.27,95%CI(1.40,3.68),P<0.01]、近端纤维帽旁侧枝循环[OR=1.65,95%CI(1.27,2.16),P<0.01]和J-CTO评分≥3分[OR=2.53,95%CI(1.53,4.16),P<0.01]。结论当前证据表明,钙化、闭塞长度≥20 mm、病变迂曲>45°、钝性头端、开口处病变、近端纤维帽模糊、近端纤维帽旁侧枝循环和J-CTO评分≥3分均是CTO-PCI成功的冠状动脉造影影像学因素。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the angiographic predictors of chronic total occlusion(CTO)percutaneous coronary intervention(PCI).Methods The PubMed,EMbase,Cochrane Library,Web of Science,CBM,WanFang Data,and CNKI databases were electronically searched to collect observational studies on the angiographic predictors of CTO-PCI from inception to December 18,2022.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of 36 studies were included.The results of meta-analysis showed that the angiographic predictors of CTO-PCI included calcification(OR=1.92,95%CI 1.49 to 2.47,P<0.01),occlusion length≥20mm(OR=1.80,95%CI 1.26 to 2.57,P<0.01),bending>45°(OR=2.19,95%CI 1.56 to 3.08,P<0.01),blunt stump(OR=1.53,95%CI 1.08 to 2.16,P<0.01),ostial lesions(OR=2.27,95%CI 1.34 to 3.85,P<0.01),proximal cap ambiguity(OR=2.27,95%CI 1.40 to 3.68,P<0.01),side branch at proximal cap(OR=1.65,95%CI 1.27 to 2.16,P<0.01),and J-CTO score≥3(OR=2.53,95%CI 1.53 to 4.16,P<0.01).Conclusion Current evidence indicates that calcification,occlusion length≥20mm,bending>45°,blunt stump,ostial lesions,proximal cap ambiguity,side branch at proximal cap,and J-CTO score≥3 are the angiographic predictors of CTO-PCI.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.

关 键 词：冠状动脉慢性完全闭塞 经皮冠状动脉介入治疗 预测因素 系统评价 META分析 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]