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CASTLE score versus J-CTO score for the prediction of technical success in chronic total occlusion percutaneous revascularisation.

CASTLE 评分与 J-CTO 评分用于预测慢性完全闭塞经皮血运重建的技术成功。

  • 影响因子:2.41
  • DOI:10.4244/EIJ-D-19-00352
  • 作者列表:"Kalogeropoulos AS","Alsanjari O","Keeble TR","Tang KH","Konstantinou K","Katsikis A","Jagathesan R","Aggarwal RK","Clesham GJ","Kelly PA","Werner GS","Hildick-Smith D","Davies JR","Karamasis G
  • 发表时间:2020-04-03
Abstract

AIMS:We sought to compare the efficiency of the novel EuroCTO (CASTLE) score with the commonly used Multicentre CTO Registry in Japan (J-CTO) score in predicting procedural success of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTOs). METHODS AND RESULTS:We evaluated 660 consecutive CTO PCIs (mean age 66±11 years, 84% male). The mean J-CTO and EuroCTO (CASTLE) scores were 1.86±1.2 and 1.74±1.2, respectively. Antegrade wire escalation, antegrade dissection re-entry and retrograde approach were used in 82%, 14% and 37% of cases, respectively. Receiver operating characteristic analysis demonstrated equal overall discriminatory capacity between the two scores (AUC 0.698, 95% CI: 0.653-0.742, p<0.001 for J-CTO vs AUC 0.676, 95% CI: 0.627-0.725, p<0.001 for EuroCTO; AUC difference: 0.022, p=0.5). However, for more complex procedures (J-CTO ≥3 or EuroCTO [CASTLE] ≥4]), the predictive capacity of the EuroCTO (CASTLE) score appeared superior (AUC 0.588, 95% CI: 0.509-0.668, p=0.03 for EuroCTO [CASTLE] score vs AUC 0.473, 95% CI: 0.393-0.553, p=NS for the J-CTO score, AUC difference: 0.115, p=0.04). CONCLUSIONS:In this study, the novel EuroCTO (CASTLE) score was comparable to the J-CTO score in predicting CTO PCI outcome with a superior discriminatory capacity for the more complex cases.

摘要

目的: 我们试图比较新型 EuroCTO (城堡) 评分与日本常用的多中心 CTO 登记处 (J-CTO) 的效率评分预测冠状动脉慢性完全闭塞病变 (CTOs) 经皮冠状动脉介入治疗 (PCI) 的手术成功率。 方法和结果: 我们评价了 660 例连续 CTO PCIs (平均年龄 66 ± 11 岁,84% 例男性)。平均 J-CTO 和 EuroCTO (CASTLE) 评分分别为 1.86 ± 1.2 和 1.74 ± 1.2。顺行钢丝升级、顺行解剖复位和逆行入路分别用于 82% 、 14% 和 37% 的病例。受试者操作特征分析显示两个评分之间的总体区分能力相等 (AUC 0.698,95% CI: 0.653-0.742,J-CTO 与 AUC 0.001,0.676 CI 的 p <95%: 0.627-0.725,欧 cto p<0.001; AUC 差值: 0.022,p = 0.5)。然而,对于更复杂的程序 (J-CTO ≥ 3 或 EuroCTO [CASTLE] ≥ 4),EuroCTO (CASTLE) 评分的预测能力出现优越 (AUC 0.588, 95% CI: 0.509-0.668,EuroCTO [CASTLE] 评分 p = 0.03 vs AUC 0.473,95% CI: 0.393-0.553,J-CTO 评分 p = NS,AUC 差值: 0.115,p = 0.04)。 结论: 在本研究中,新型 EuroCTO (CASTLE) 评分在预测 CTO PCI 结局方面与 J-CTO 评分相当,对更复杂的病例具有优越的区分能力。

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影响因子:10.49
发表时间:2020-01-02
DOI:10.1172/JCI124708
作者列表:["Jain M","Dhanesha N","Doddapattar P","Chorawala MR","Nayak MK","Cornelissen A","Guo L","Finn AV","Lentz SR","Chauhan AK"]

METHODS::Fibronectin-splice variant containing extra domain A (Fn-EDA) is associated with smooth muscle cells (SMCs) following vascular injury. The role of SMC-derived Fn-EDA in SMC phenotypic switching or its implication in neointimal hyperplasia remains unclear. Herein, using human coronary artery sections with a bare metal stent, we demonstrate the expression of Fn-EDA in the vicinity of SMC-rich neointima and peri-strut areas. In mice, Fn-EDA colocalizes with SMCs in the neointima of injured carotid arteries and promotes neointima formation in the comorbid condition of hyperlipidemia by potentiating SMC proliferation and migration. No sex-based differences were observed. Mechanistic studies suggested that Fn-EDA mediates integrin- and TLR4-dependent proliferation and migration through activation of FAK/Src and Akt1/mTOR signaling, respectively. Specific deletion of Fn-EDA in SMCs, but not in endothelial cells, reduced intimal hyperplasia and suppressed the SMC synthetic phenotype concomitant with decreased Akt1/mTOR signaling. Targeting Fn-EDA in human aortic SMCs suppressed the synthetic phenotype and downregulated Akt1/mTOR signaling. These results reveal that SMC-derived Fn-EDA potentiates phenotypic switching in human and mouse aortic SMCs and neointimal hyperplasia in the mouse. We suggest that targeting Fn-EDA could be explored as a potential therapeutic strategy to reduce neointimal hyperplasia.

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影响因子:4.65
发表时间:2020-01-01
DOI:10.1161/ATVBAHA.119.313602
作者列表:["Lee SY","Ahn JM","Mintz GS","Hong SJ","Ahn CM","Park DW","Kim JS","Kim BK","Ko YG","Choi D","Jang Y","Park SJ","Hong MK"]

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