术前CT血管成像对慢性完全闭塞病变介入治疗结果预测价值的研究  

Value of preoperative CT angiography in predicting the outcome of interventional therapy for chronic total occlusion

作　　者：马琳莹 赵晶石 李小路 刘芳[1] 张同[1] Ma Linying;Zhao Jingshi;Li Xiaolu;Liu Fang;Zhang Tong(Department of Radiology,the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China)

机构地区：[1]哈尔滨医科大学附属第四医院影像科,150001

出　　处：《中国心血管杂志》2020年第2期151-155,共5页Chinese Journal of Cardiovascular Medicine

基　　金：黑龙江省科技局项目(2017RAXXJ041)。

摘　　要：目的分析影响慢性完全闭塞病变(CTO)经皮冠状动脉介入治疗(PCI)结果的影像特征,评估术前CT血管造影成像(CCTA)对CTO介入治疗结果预测价值,以及对比J-CTO评分和CT-RECTOR评分系统对CTO介入结果的预测效能。方法回顾性分析113例患者,共114处病变血管,根据PCI结果分为成功组(84例)与失败组(30例)。分析CCTA影像特征,包括闭塞长度、血管弯曲角度、重构类型等,多因素logistic回归分析导致PCI失败的因素。ROC曲线下面积对比评估J-CTO评分和CT-RECTOR评分的预测效能。结果PCI失败组的血管弯曲角度大于45°(30.0%比4.8%,P=0.001)、钝形闭塞(60.0%比14.2%,P<0.001)、钙化程度大于50%(36.7%比8.3%,P=0.004)、负性重构(66.7%比31.0%,P=0.001)、闭塞段长度[(22.06±16.09)mm比(16.15±10.67)mm,P=0.026]均大于PCI成功组。多因素logistic分析显示负性重构、血管弯曲大于45°、钝形闭塞的病变行PCI失败率高(均为P<0.05)。CT-RECTOR评分预测介入治疗成功率高于J-CTO评分(85.4%比76.8%,P<0.05),差异有统计学意义。结论负性重构、血管弯曲大于45°、钝形闭塞是影响CTO患者手术失败的主要因素;CT-RECTOR评分更有助于预测CTO行PCI手术结果,术前CCTA检查有助于预测PCI手术结果。Objective To analyze conventional coronary CT angiography(CCTA)imaging results in patients with chronic total occlusions(CTO)before percutaneous coronary intervention(PCI)and to compare the predictive efficacy of J-CTO score and CT-RECTOR score system on the outcome of CTO intervention.Methods A retrospective analysis of 114 occluded vessels from 113 patients was divided into the PCI success group(84 vessels)and the PCI failure group(30 vessels)according to the results of PCI.The imaging features of CCTA included occlusion length,bending>45°,and remodeling shape,among other parameters.The area under the receiver operating characteristic curve was used to assess the predictive efficacy of the J-CTO score,CT-RECTOR score.Results The PCI failure group was associated with significantly higher incidences of blood vessel curvature greater than 45°(30.0%vs.4.8%,P=0.001),blunt occlusion(60.0%vs.14.2%,P<0.001),calcification greater than 50%(36.7%vs.8.3%,P=0.004),negative remodeling(66.7%vs.31.0%,P=0.001),and a longer length of the occluded section[(22.06±16.09)mm vs.(16.15±10.67)mm,P=0.026]than those in the PCI success group.Multivariate logistic regression analyses showed that negative remodeling,vascular bending greater than 45°,blunt shaped block were the risk factors of PCI failure(all P<0.05).CT-RECTOR score was better for predicting PCI success rate than the J-CTO score(85.4%vs.76.8%,P<0.05).Conclusions Negative remodeling,vascular bending greater than 45°,and blunt shaped block are the main factors influencing surgical failure rate for the CTO patients.CT-RECTOR score is more helpful in predicting the PCI outcome for CTO lesions.Preoperative CCTA examination is helpful in predicting PCI outcomes.

关 键 词：冠状动脉CT血管成像 慢性完全闭塞 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]