侧支循环良好、不良的冠状动脉前降支慢性完全闭塞血运重建成功患者预后对比观察  

Comparative observation on prognosis of successful revascularization of chronic total occlusion of the anterior descending coronary artery with good or poor collateral circulation

作　　者：张文远 李亚彭[1] 张彦周[1] ZHANG Wenyuan;LI Yapeng;ZHANG Yanzhou(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052

出　　处：《山东医药》2020年第33期10-13,共4页Shandong Medical Journal

摘　　要：目的观察侧支循环良好、不良的冠状动脉前降支慢性完全闭塞(LAD-CTO)血运重建成功患者的预后,并进行对比分析。方法LAD-CTO血运重建成功的患者123例,按照Rentrop分级标准分为侧支循环不良组(Rentrop 0-1级,45例)、侧支循环良好组(Rentrop 2-3级,78例)。两组患者均接受冠状动脉造影检查,依据检查结果判定患者冠脉病变特点,如血管病变支数、多支CTO病变数量、LAD-CTO病变部位,并根据冠脉病变特点计算慢性完全闭塞病变介入策略预测评分(J-CTO评分)及冠脉病变评分(SYNTAX评分)。收集并比较两组患者血运重建术前及随访时的左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室短轴缩短率(FS)等左心功能指标。患者均接受随访,随访主要终点为全因死亡,次要终点为心源性死亡、再发心肌梗死(MI)、支架内再狭窄(ISR)、再次血运重建、心衰再住院、脑卒中等主要心脑血管不良事件(MACCE)。结果两组血管病变支数、多支CTO病变数量、LAD-CTO病变部位等冠脉病变特点相比,P均>0.05。侧支循环不良组J-CTO评分、SYNTAX评分分别为(1.51±0.59)、(23.31±5.36)分,侧支循环良好组分别为(1.18±0.80)、(21.41±4.12)分,两组相比,P均<0.05。随访时侧支循环不良组LVEF、FS低于侧支循环良好组(P均<0.05),LVEDV、LVEDS高于侧支循环良好组(P均<0.05)。两组全因死亡、心源性死亡、MI、ISR、靶血管血运重建(TVR)、非靶血管血运重建(NTVR)、心衰再住院、脑卒中、MACCE等临床终点相比,P>0.05。结论在LAD-CTO血运重建成功患者中,侧支循环良好的患者左心功能改善效果更好,侧支循环情况对LAD-CTO病变血运重建成功患者的短期预后影响无差异。Objective To observe and compare the prognosis of successful revascularization of chronic total occlusion of the anterior descending coronary artery(LAD-CTO)with good or poor collateral circulation.Methods There were 123 patients with successful LAD-CTO revascularization.According to Rentrop classification,123 patients with successful LADCTO revascularization were divided into two groups:poor collateral circulation group(Rentrop 0-1,n=45)and good collateral circulation group(Rentrop 2-3,n=78).Patients in both groups were examined by coronary angiography,and the characteristics of coronary artery lesions,such as the number of diseased vessels,the number of multiple CTO lesions,and the location of LAD-CTO lesions,were determined according to the results of coronary angiography.According to the characteristics of coronary artery lesions,the interventional strategy predictive score(J-CTO score)and coronary lesion score(SYNTAX score)of chronic total occlusive lesions were calculated.The left ventricular function indexes such as left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and left ventricular short-axis shortening rate(FS)were collected and compared between the two groups before and after revascularization.All patients were followed up.The main endpoint of follow-up was all-cause death,and the secondary endpoints were major cardio-cerebrovascular adverse events(MACCE)composed of cardiogenic death,recurrent myocardial infarction(MI),in-stent restenosis(ISR),revascularization,re-hospitalization of heart failure,and stroke.Results No statistically significant differences were found in the location of LAD-CTO lesions,the number of diseased vessels and multiple CTO lesions,or other characteristics of coronary artery lesions between the two groups(all P>0.05).The mean J-CTO score and SYNTAX score were(1.51±0.59)and(23.31±5.36)points in the poor collateral circulation group,versus(1.18±0.80)and(21.41±4.12)points in the good collateral ci

关 键 词：冠心病 冠状动脉慢性完全闭塞 前降支慢性完全闭塞 侧支循环 侧支血管 

分 类 号：R541.1[医药卫生—心血管疾病]