冠状动脉不同分支慢性完全闭塞病变再血管化后中远期预后及其影响因素分析  

Comparison of middle and long term effects after PCI revascularization in patients with chronic total occlusion of different branches of coronary artery

作　　者：时小凤 王昭军[1] 严金川[1] 沈俊飞[1] 邵海锐 SHI Xiaofeng;WANG Zhaojun;YAN Jinchuan;SHEN Junfei;SHAO Hairui(Department of Cardiology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院心内科,江苏省镇江市212001

出　　处：《中国动脉硬化杂志》2019年第2期141-149,共9页Chinese Journal of Arteriosclerosis

基　　金：镇江市重点(医卫)项目(SH2015029)

摘　　要：目的比较分析冠状动脉不同分支慢性完全闭塞病变(CTO)行经皮冠状动脉介入治疗(PCI)再血管化后的中远期预后及其影响因素。方法纳入经选择性冠状动脉造影证实为CTO的患者共122例,按照CTO病变部位[左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)]分为不同分支病变,对其中113例患者实施PCI。随访观察PCI成功再血管化组与同期未再血管化组(包括PCI未成功及未行PCI)患者的中远期预后,包括生存率、主要不良心脏事件(MACE)、左心室功能;比较不同分支CTO病变再血管化后中远期效果的差异,并分析影响预后的临床因素。结果 113例行PCI的CTO患者中81例成功再血管化(其中RCA病变30例,LAD病变32例,LCX病变5例,两支及多支病变14例)。在随访期内[(26.7±20.7)月],成功再血管化组总的累积无事件生存率显著高于未再血管化组(70.4%比58.5%,P=0.042),不良事件总发生率显著低于未再血管化组(24.7%比56.1%,P=0.021)。全部CTO病例成功再血管化后总的左心室射血分数(EF)增加值[(3.1±1.4)%]与未再血管化组[(0.3±1.2)%]比较,差异有统计学意义(P=0.038)。RCA病变、LAD病变、两支及多支病变成功再血管化组不良事件发生率明显低于未再血管化组(P分别为0.002、0.017、0.013),LCX病变患者两组间差异无统计学意义(P=0.408)。RCA病变、LAD病变成功再血管化组ΔEF[分别为(3.6±1.7)%、(4.1±1.8)%](P分别为0.045、0.038)、左心房内径变化值(ΔLAD,P分别为0.031、0.035)、左心室舒张期末内径变化值(ΔLVEDD,P分别为0.012、0.024)、左心室收缩期末内径变化值(ΔLVESD,P分别为0.018、0.031)及右心房内径变化值(ΔRAD,P分别为0.037、0.028),与未再血管化组相比差异有统计学意义,而LCX病变、两支及多支病变成功再血管化组ΔEF[分别为(0.6±0.3)%、(0.8±0.3)%](P分别为0.115、0.475)、ΔLAD(P分别为0.315、0.236)、ΔLVEDD(P分别为0.287、0.381)、ΔLVESD(P分别为0.348、0.341)Aim To compare the middle and long term prognosis and analyze the influencing factors of chronic total occlusion( CTO) in different branches of coronary artery after percutaneous coronary intervention( PCI) revascularization. Methods A total of 122 patients with CTO confirmed by selective coronary angiography were divided into different branches of lesions according to the lesion location of CTO( left anterior descending artery( LAD),left circumflex artery( LCX),and right coronary artery( RCA)). 113 of them were tried to implement PCI,and the prognosis( survival rate,major adverse cardiac events,left ventricular function) of those with successful PCI and non-revascularization( including unsuccessful PCI and non-PCI) were observed through following up. The middle and long term effects of different branches of CTO after revascularization were compared,and the clinical factors that affect the prognosis were analyzed. Results Among the 113 CTO patients who underwent PCI,81 cases were successfully revascularized( including 30 cases of RCA,32 cases of LAD,5 cases of LCX and 14 cases of two or more branches lesions). The cumulative event-free survival rate in the successful PCI revascularization group was significantly higher than that in the non-revascularization group( 70.4% vs 58.5%,P= 0.042) during the mean follow-up of( 26.7±20.7) months,and the total incidence of adverse events was significantly lower than that in the non-revascularization group( 24.7% vs 56.1%,P = 0.021). In RCA group,LAD group and two or more CTO lesions group,the incidence of recurrent angina pectoris,heart failure,MACE and allcause death in those successfully treated with revascularization were significantly lower than that of non-revascularization group( P value of these groups was 0.002,0.017,0.013,respectively). There was no significant difference in LCX group( P= 0.408). The total increased left ventricular EF(( 3.1±1.4) %) after successful PCI in all patients with CTO was significantly higher than that in the non-revascularization group

关 键 词：冠状动脉慢性完全闭塞 经皮冠状动脉介入治疗 靶血管 主要不良心脏事件 生存分析 

分 类 号：R5[医药卫生—内科学]