经皮冠状动脉内介入治疗慢性完全闭塞病变影响因素探讨  

Influential factor of percutanenous coronary intervention to chronic total occlusion

作　　者：丁澍[1] 严金川[1] 马根山[2] 冯毅[2] 沈成兴[2] 陈忠[2] 

机构地区：[1]江苏大学附属医院心内科,江苏镇江212001 [2]东南大学附属中大医院心内科,江苏南京210009

出　　处：《江苏大学学报（医学版）》2007年第2期158-160,共3页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:探讨慢性完全闭塞性病变(CTO)经皮冠状动脉介入(PCI)治疗的影响因素。方法:回顾2000年4月至2006年6月东南大学附属中大医院行PCI治疗的CTO患者48例,CTO病变共51处,记录患者临床特征、靶病变特点和靶病变PCI操作结果,行logistic逐步回归分析,筛选PCI成功的预测因素。结果:48例患者中33例36处成功,15例15处失败,病例成功率68.8%,靶病变成功率70.6%。2000年4月至2003年5月10例患者10处病变4例4处成功,病例及病变成功率均为40.0%;2003年6月至2006年6月38例患者41处病变中29例32处成功,成功率分别为76.3%,78.0%。2003年6月之后病变成功率较之前明显提高(P<0.05)。经logistic逐步回归分析,介入操作成功的预测因素为桥侧支缺如(P=0.001)、病变闭塞持续时间≤3个月(P=0.005)、功能性闭塞(P=0.005)、病变近端呈鼠尾状(P=0.026)。结论:CTO介入治疗操作成功率除与术者经验和新型介入器材应用有关外,与病变特点密切相关,而与临床特点关系较小。在病变特点中,桥侧支缺如、病变闭塞持续时间≤3个月、功能性闭塞、病变近端呈鼠尾状是CTO行PCI操作成功的预测因素。Objective： To investigat the influential factors of percutanenous coronary intervention （PCI） to chronic total occlusion （CTO）. Methods： All of 48 patients （51 CTO lesions）to PCI were reviewed from April, 2000 to June,2006 at the Affiliated Zhongda Hospital of Southeast University. Clinical feature, characteristic of target lesions, and procedure efficacy were recorded. Their relationships were determined by logistic stepwise regression analysis, and predict factors on successful procedure were sieved. Results： The total case achievement ratio was 68.8% ,and the total lesion achievement ratio was 70.6% （33 patients and 36 CTOs were procedural success）. The case achievement ratio and the lesion achivement ratio were beth 40% from April ,2000 to May,2003 （4 patients and 4 CTOs were procedural success among 10 patients and 10 CTOs）, and the ratio was respectively 76. 3% and 78.0% from June ,2003 to June ,2006（29 patients and 32 CTOs were procedural success among 38 patients and 41 CTOs）. The lesion achivement ratio was markedly rised after June,2003 compared with the time before （P 〈 0.05）. By logistic stepwise regression analysis predict factors on successful procedure were absence of bridge collateral （ P = 0. 001 ）, lesion occlusion duration ≤ three months （P = 0. 005 ）, functional occlusion （ P = 0. 005 ） and lesion proximate of rat-tail （ P = 0. 026 ）. Conclusion： The procedure achievement ratio was more correlated with characteristic of target lesions besides operator experience and application of neotype intervention equipment, and less correlated with clinical features. The clinical features of predict factors on successful proeedure were absence of bridge collateral, lesion occlusion duration ≤ three months, functional occlusion and lesion proximate of rat-tail.

关 键 词：慢性完全闭塞性病变 经皮冠状动脉介入治疗 预测因素 

分 类 号：R542.2[医药卫生—心血管疾病]