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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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CTo-aBCDE score: A new predictor of success in CTOs
Session:
CO3 - Doença Coronária
Speaker:
Inês Ricardo
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Aguiar Ricardo; Pedro Pinto Cardoso; Joana Rigueira; Miguel Nobre Menezes; P. Carrilho Ferreira; E. Infante de Oliveira; Claudia Jorge; Diogo Torres; José Marques da Costa; J. Almeida Duarte; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong> The selection of patients for angioplasty (PCI) for chronic occlusion (CTO) is crucial for the success of the procedure. The intention is to identify independent predictors of success in PCI for CTOs, in order to create a score of good acuity.</p> <p><strong>Methods:</strong> unicentric observational recording of PCI in CTOs. Demographic and clinical characteristics of the patients and anatomical characteristics of the coronary disease were registered. To identify predictors of success, linear regression analysis was used for quantitative variables and logistic regression for qualitative variables. Based on the results, a predictive success score was constructed. Its acuity was verified by analysis with the Receiver Operator Curve (ROC curve).</p> <p>Results: 377 interventions were performed in 334 patients (68 ± 11 years, 75% men), success rate per patient was 65% and per procedure was 60%.</p> <p>In a univariate analysis, the following were predictors of success: absence of active smoking (OR 2.02, 95% CI 1.243-3.29, p = 0.005); presence of a sharp stump (C) (OR 5.2, 95% CI 2.7-10.2, p <0.001), absence of significant intraocclusion tortuosity (To) (OR 6.44, 95% CI 3, (OR = 1.95, 95% CI 1.08-3.51, p = 0.026), absence of significant calcification (C) (OR 3, p <0.001), absence of bifurcation 1, 95% CI 3.10-5.41, p <0.001), anterior descending target vessel (D) (OR 1.9, 95% CI 1.0-3.5, p = 0.048), and extension of the occlusion <20 mm (E) (OR 3.00, 95% CI 1.69-5.3, p <0.001). In a multivariate analysis, only anatomical factors were independent predictors of success, with no clinical predictors. Based on these data an anatomical score was created with high acuity (AUC 0.831), with values ??between 0 and 11. A score <3 was associated with a reduced success probability (15%), a score between 3-8 with intermediate probability (55%), and a score> 8 high probability of success (95%).</p> <p><strong>Conclusion: </strong>in patients undergoing CTO PCI, only the anatomical characteristics of the disease are predictive of success when adjusted for clinical factors. The creation of a success score of good acuity may allow to select the cases that can be intervened by any operator, those in which an operator dedicated to occlusions will be desirable, and those in which the probability of success is extremely low, and should be considered if the case conservative management, surgical revascularization.</p>
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