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Nanjing Heart Center
Asian Bifurcation Club (ABC)
Nanjing First Hospital, Nanjing Medical University
Co-organized by
Chinese Society of Cardiology (CSC)
Capacity Building and Continuing Education Center,National Health and Family Planning Commission (CBCEC)
American Society for Cardiovascular Angiography and Interventions (SCAI)
Asian Heart Society (AHS)
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Registration Administration of Domestic Representatives
Hongjuan Peng :
+86-13913895477
Haimei Xu +86-13914736846
cbsnj@cbsmd.cn
Registration Administration of Overseas Representatives
Ling Lin : +86 (25) 52271398
+86-13951884596
cbs@cbsmd.cn
Management of Challenging Cases
Yingying Zhao :+86-13815408517
sub@cbsmd.cn
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210006
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Recommended Paper
Management of Acute Myocardial Infarction During the COVID-19 Pandemic
COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up
CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic
ACC Clinical Bulletin Focuses on Cardiac Implications of Coronavirus (COVID-19)
Congestive Heart Failure
Original Research
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EuroCTO俱乐部成立于2006年12月，先后发表了2007版和2012版CTO血管再通专家共识，2019年1月发布了2019版欧洲CTO专家共识“Percutaneous Recanalization of Chronic Total Occlusions: 2019 Consensus Document from the EuroCTO Club”，该共识更新了自2012年后累积的最新CTO的科学证据，讨论CTO PCI的临床指征和侧支循环、论证了CTO血管再通的合理性、介绍了介入技术、器械以及对术者/介入中心的资质提出了要求。
冠脉CTO病变被定义为冠状动脉狭窄程度达100%，TIMI血流0级达三个以上的冠状动脉病变，文中指出的有关CTO PCI的几个核心数据及发现：
1. 经冠脉造影明确的冠脉CTO 患病率占CAD人群的15-25%；
2. 右冠CTO最常见，占冠脉CTO的50%左右；
3. 有CABG治疗史中约有90%的患者存在CTO病变；但仅有十分之一的STEMI患者被确诊为CTO患者。
CTO病变血管再通后除了改善心肌缺血处心肌灌注（myocardial perfusion）外，还可缓解因心肌缺血导致的心绞痛、改善心功能、提高生活质量；反之，不完全血运重建与永久性左心室功能障碍相关；另有复律除颤器队列人群研究证实， CTO病变人群更易发生恶性心律不齐。
既往的证据均是建立在CTO PCI是否成功基础上的，因此缺乏支持CTO血管再通的可靠证据，现CTO PCI的指南推荐级别为Class IIa B。最新经EUROCTO采信的RCT研究区别于既往，均以OMT为对照：
1. 采信EUROCTO Trail的理由是纳入研究的非CTO病变均在随机前得以治愈，确保观察到了CTO PCI的独立疗效。在CTO PCI的临床价值还未得到RCT研究证实的背景下，EUROCTO研究从CTO PCI对稳定性心绞痛的健康改善的角度比较与单独使用OMT治疗CTO的差异。 390名至少有一处CTO的患者以2:1的入组比例参与了此项前瞻性、多中心、非盲、对照试验。主要研究终点是根据西雅图心绞痛问卷（Seattle angina questionnaire， SAQ）判断12个月相较于基线的健康改善。SAQ量表显示12个月时，无论是PCI对心绞痛改善程度（5.23, 95% confidence interval (CI) 1.75; 8.71; P = 0.003）、生命质量指标的改善(6.62, 95% CI 1.78-11.46; P = 0.007)，还是生理限制的改善均达到了预设目标。PCI组完全行动能力恢复比例显著高于OMT组(P = 0.008)。而12个月内两组MACE未观察到差异。
2. IMPACTOR CTO研究现今暂未开放阅读。
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