Analysis of the Canadian database of patients with Chronic Total Occlusion - Percutaneous Coronary Intervention
Notice bibliographique
Résumé
Background: Chronic total occlusions (CTOs) are complete blockages of coronary arteries observed in roughly one out of every 5 patients with coronary artery disease (CAD). Percutaneous coronary intervention (PCI) is a minimally invasive procedure used to treat CAD. However, its chances of success were initially reported to be lower in patients with CTO. Recent improvements in technology and techniques have improved these chances. Furthermore, centres with higher volumes tend to report better outcomes. The available evidence to date is largely drawn from registry studies in the United States and Japan. Given the potential for variation in patient characteristics, practice patterns and outcomes across settings, there is a need to examine the Canadian experience in CTO PCI.Objectives: 1)To characterize patients undergoing CTO PCI in Canada2)To estimate the impact of previously reported risk factors for procedural success and complications in this population. 3)To examine characteristics of patients receiving antegrade vs. retrograde CTO PCI4)To estimate the impact of risk factors for procedural success and complications among subjects who received antegrade vs. retrograde CTO PCI Methods: This thesis reports on the first analysis of the Canadian CTO PCI registry (CCTOP), the first multicentre Canadian cohort of patients who underwent CTO-PCI in one of six major participating tertiary care centres during 2014 to 2019. A review of the literature is provided, including registry studies from other jurisdictions. Descriptive statistics were used to summarize demographic and clinical characteristics of patients, and characteristics of CTO-PCI procedures applied in CCTOP. The outcomes of interest included short-term procedural success of CTO-PCI, defined as technical success without major complication within 30 days and complications. Logistic regression and classification and regression tree (CART) models were used to estimate the association between each risk factors for procedural success. Results: A total 1194 consecutive patients were examined among whom 549 underwent antegrade-only (46 %) and 525 underwent retrograde (44%) CTO-PCI procedures. Procedural success was high overall (n=928, 88%). It was higher for antegrade vs. retrograde procedures as expected (91% vs. 81%). Important predictors of an unsuccessful CTO-PCI included presence of a prior Coronary Artery Bypass Graft (CABG) procedure (OR, 0.46, [95% CI, 0.22,0.94]), severely reduced Left Ventricular Ejection Fraction (LVEF) (OR, 0.29, [95% CI, 0.10,0.88]), collateral that were not crossed(OR, 0.10, [95% CI, 0.04,0.29]), ambiguity in the proximal cap(OR, 0.50, [95% CI, 0.25,0.99]). Classification and Regression Trees (CART) analysis did not identify any interactions between the risk factors studied.Conclusions: This analysis demonstrates that the Canadian experience with CTO-PCI is comparable to other major centres worldwide in terms of the high overall success and low risk of complications. Further, it shows that retrograde procedures can be attempted with a high level of success for certain groups of patients
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,008 | 0,016 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,002 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».