BackgroundThere is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non‐US centers between 2012 and 2023.ResultsOf 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non‐ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non‐ACA CTO PCI).ConclusionsCTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non‐ACA CTO PCI.

中文翻译：

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异常冠状动脉的慢性完全闭塞经皮冠状动脉介入治疗：来自 PROGRESS CTO 登记处的见解


背景关于异常冠状动脉 （ACA） 中慢性完全闭塞 （CTO） 经皮冠状动脉介入治疗 （PCI） 的频率和结果的信息有限。方法我们检查了 2012 年至 2023 年在 46 个美国和非美国中心接受 14,470 例 CTO PCI 的 14,173 例患者的 ACA 中 CTO PCI 的临床和血管造影特征以及手术结果结果在 14,470 例 CTO PCI 中，36 例 （0.24%） 是 ACA 中的 CTO PCIs。ACA 患者与无 ACA 患者具有相似的基线特征。发现 CTO 病变的 ACA 类型如下：右冠状动脉 （ARCA） 异常起源 （17， 48.5%），左回旋支冠状动脉异常起源 （9， 25.7%），左前降支和左回旋支动脉起源不同 （4， 11.4%），左前降支异常起源 （2， 5.7%）， 双左前降支 （2， 5.7%） 和编织冠状动脉 1 （2.8%）。两组之间的日本 CTO 评分相似 （2.17 ± 1.32 vs 2.38 ± 1.26，p = 0.30）。ACA 患者的目标 CTO 更可能患有中度/重度迂曲（44% vs 28%，p = 0.035），需要更频繁地使用逆行入路（27% vs 12%，p = 0.028），并且与更长的手术时间（142.5 分钟 vs 112.00 分钟 [74.0， 164.0]，p = 0.028）和透视（56 分钟 [40， 79 ml] vs 42 分钟 [25， 67]，p = 0.014） 时间和更高的造影剂体积 （260 ml [190， 450] vs 200 ml [150， 300]，p = 0.004），但具有相似的程序 （91.4% vs 85.6%，p = 0.46） 和技术 （91.4% vs 87.0%，p = 0.59） 成功。在 ACA 患者中未观察到主要不良心脏事件 （MACE） （0% [0] vs 1.9% [281] 在非 ACA 患者中，p = 1.00）。ACA CTO PCI 报告了 2 例冠状动脉穿孔 （p = 0.7 vs. 非 ACA CTO PCI）。结论ACA 的 CTO PCI 占 PROGRESS CTO 登记处执行的所有 CTO PCI 的 0.24%，与非 ACA CTO PCI 相比，程序复杂性较高，但技术和程序成功率相似，MACE 相似。