左主干合并慢性完全闭塞病变介入治疗效果及三年随访分析  

Percutaneous Coronary Intervention of Left Main Disease With Chronic Total Occlusion Lesion:3-year Follow-up Results

作　　者：崔锦钢[1] 田涛[1] 管常东 胡奉环[1] 杨伟宪[1] 杨跃进[1] 吴永健[1] 袁晋青[1] 袁建松[1] 唐熠达[1] 窦克非[1] 刘海波[1] 高展[1] 陈珏[1] 徐波[2] 陈纪林[1] 高润霖[1] 乔树宾[1] CUI Jingang;TIAN Tao;GUAN Changdong;HU Fenghuan;YANG Weixian;YANG Yuejin;WU Yongjian;YUAN Jinqing;YUAN Jiansong;TANG Yida;DOU Kefei;LIU Haibo;GAO Zhan;CHEN Jue;XU Bo;CHEN Jilin;GAO Runlin;QIAO Shubin(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,心内科,北京市100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,介入导管室,北京市100037

出　　处：《中国循环杂志》2020年第9期888-893,共6页Chinese Circulation Journal

基　　金：中国医学科学院临床应用评估项目(T2018-ZX002)。

摘　　要：目的:探讨左主干(LM)合并慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)的效果及长期预后。方法:回顾性纳入2004年1月至2015年12月于中国医学科学院阜外医院行冠状动脉LM介入治疗的患者3960例,按照LM病变是否合并CTO病变,分为LM合并CTO病变组(n=91)和LM不合并CTO病变组(n=3869),比较两组患者的临床特点和长期预后。结果:与LM不合并CTO病变组患者相比,LM合并CTO病变组患者既往心肌梗死比例较高(26.1%vs.40.7%),左心室射血分数较低[(63.1±7.7)%vs.(59.6±10.4)%],病变长度[(27.1±19.3)mm vs.(40.9±25.5)mm]及置入的支架长度[(31.9±19.8)mm vs(.45.8±27.1)mm]均较长,SYNTAX评分[(22.9±7.2)分vs.(27.2±7.3)分]较高,再狭窄病变(2.8%vs.6.6%)、LM钙化病变(12.5%vs.19.8%)、血栓性病变(1.1%vs.13.2%)比例及主动脉内球囊反搏应用率(7.4%vs.16.5%)、介入操作并发症发生率(2.0%vs.5.5%)均较高,上述差异均有统计学意义(P均<0.05)。所有患者中3年全因死亡率为3.5%。Kaplan-Meier生存分析显示,LM合并CTO病变组3年全因死亡率(11.0%vs.3.4%)和心肌梗死发生率(13.2%vs.4.1%)均明显高于LM不合并CTO病变组(P均<0.05)。结论:PCI对适宜的LM病变是可选择的治疗方法,但对于LM合并CTO病变患者,PCI并发症发生率较高,不良心脏事件明显增加,因此此类患者应慎行PCI。Objectives:To investigate the effect and long-term prognosis of percutaneous coronary intervention(PCI)of left main(LM)disease combined with chronic total occlusion(CTO)lesion.Methods:A total of 3960 patients with LM disease undergoing interventional therapy from January 2004 to December 2015 in Fuwai Hospital were retrospectively analyzed.All these subjects were divided into two groups:patients with CTO lesion group(n=91)and without CTO lesion group(n=3869).Clinical characteristics and long-term outcome were compared between the two groups.Results:Compared with the patients without CTO lesion,the patients with CTO lesion had a higher proportion of previous myocardial infarction(26.1%vs.40.7%),a lower left ventricular ejection fraction([63.1±7.7]%vs.[59.6±10.4]%),a longer lesion length([27.1±19.3]mm vs.[40.9±25.5]mm)and implanted stent length([31.9±19.8]mm vs.[45.8±27.1]mm),SYNTAX score(22.9±7.2 vs.27.2±7.3)were higher,the proportions of restenosis lesion(2.8%vs.6.6%),LM calcification lesion(12.5%vs.19.8%)and thrombosis lesion(1.1%vs.13.2%)were higher,more intra-aortic balloon pump was implanted(7.4%vs.16.5%),complications of operation(2.0%vs.5.5%)were higher(all P<0.05).The 3-year all-cause mortality rate was 3.5%in all patients.Kaplan-Meier survival analysis showed that the 3-year all-cause mortality(11.0%vs.3.4%)and the incidence of myocardial infarction(13.2%vs.4.1%)were significantly higher in the patients with CTO lesion than those without CTO lesion(both P<0.05).Conclusions:PCI is an alternative strategy for management of appropriate LM disease,but intervention of LM patient with CTO lesion is associated with higher risk of complications and the adverse cardiac events.Consequently,caution is needed when selecting PCI as a therapeutic strategy for these patients.

关 键 词：左主干 经皮冠状动脉介入治疗 慢性完全闭塞病变 临床预后 

分 类 号：R54[医药卫生—心血管疾病]