左回旋支慢性完全闭塞性病变经皮介入治疗长期预后分析  

Long-term Prognosis of Patients With Left Circumflex Chronical Total Occlusion After Percutaneous Coronary Intervention

作　　者：王曼[1] 杨跃进[1] 杨伟宪[1] 乔树宾[1] 徐波[1] 胡奉环[1] 宋雷[1] 刘海波[1] 管常东 WANG Man;YANG Yuejin;YANG Weixian;QIAO Shubin;XU Bo;HU Fenghuan;SONG Lei;LIU Haibo;GUAN Changdong(Coronary Heart Disease Center,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,阜外医院冠心病中心,北京市100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心介入导管室,北京市100037

出　　处：《中国循环杂志》2021年第8期749-755,共7页Chinese Circulation Journal

摘　　要：目的:分析左回旋支慢性完全闭塞性病变(CTO)的临床特点,评估经皮冠状动脉介入治疗(PCI)对患者长期(5年)预后的影响。方法:连续入选2010年1月至2013年12月在中国医学科学院阜外医院行PCI的患者375例,冠状动脉造影证实至少存在一支左回旋支CTO。记录所有患者的临床资料,根据PCI结束时的冠状动脉造影结果将患者分为成功组(n=269)和失败组(n=106)。通过门诊或电话对患者进行随访,记录主要终点(5年时的全因死亡+心肌梗死的复合终点)和次要终点[包括30 d时全因死亡、心肌梗死,5年随访时心力衰竭再住院率、任何血运重建或靶血管再次血运重建(TVR)、靶病变再次血运重建(TLR)]。结果:共入选375例左回旋支CTO患者,CTO 426处,其中男性321例(85.60%)。冠状动脉造影诊断PCI成功组269例(71.73%),失败组106例(28.27%)。失败组高血压患者比例、术前SYNTAX评分、病变长度≥20 mm患者比例、存在钝头闭塞患者比例、闭塞处存在大的边支患者比例均高于成功组(P均<0.05),J-CTO评分为0分的比例明显低于成功组(P<0.05)。失败组边支闭塞和夹层的发生率均明显高于PCI成功组(P均<0.05);穿孔的发生率虽高于成功组,但差异无统计学意义(P>0.05)。主要终点:5年随访,成功组和失败组死亡+心肌梗死复合终点发生率,差异无统计学意义(11.74%vs.6.45%,P>0.05)。次要终点:30 d死亡(0.37%vs.1.89%)和心肌梗死(1.49%vs.0.94%)的发生率两组差异无统计学意义(P均>0.05);5年随访,失败组TLR高于成功组(18.28%vs.9.72%,P=0.03),TVR虽高于成功组,但差异未达到统计学意义(18.28%vs.10.93%,P>0.05)。结论:左回旋支CTO男性患者居多,冠状动脉造影PCI成功率为71.73%,高血压患者比例较高,病变迂曲,近端存在大分支的比例较高,失败组边支闭塞、夹层的发生率高于成功组。PCI成功未降低左回旋支CTO患者的远期(5年)死亡率及心肌梗死的发生率,失败组TLR发生�Objectives:To analyze the characteristics of patients with left circumflex chronical total occlusion(CTO)and evaluate the impact of successful percutaneous coronary intervetion(PCI)on the long-term prognosis of this patient population.Methods:All patients who underwent PCI with at least one left circumflex branch(LCX)lesion between January 2010 and December 2013 at Fuwai Hospital were consecutively enrolled.Patients were divided into successful group and failure group according to the angiographic result of PCI.All baseline data were prospectively recorded.Clinical follow-up was achieved via office visit or telephone contact.The primary endpoint was the composite incidence rate of all cause death and myocardial infarction at 5 year and secondary endpoint included all-cause death and myocardial infarction at 30 days and heart failure,target lesion revascularization(TLR)and target vessel revascularization(TVR)at 5 years.Results:A total of 375 patients with LCX CTO were enrolled.There were 426 lesions,321 male patients(85.60%).Angiographic successful PCI was achieved in 269 patients(71.73%),and there were 106 failed PCI(28.27%).Failure group had higher percentage of prior history of hypertension,high pre-PCI SYNTAX score,lesion length longer than≥20 mm,blunt stump occlusion and large side branch near the occlusion site than that in successful group(all P<0.05).Rate of J-CTO score 0 was significantly higher in successful group than in failure group(P<0.05).Incidence of side branch occlusion and dissection was significantly higher in failure group than in successful group(all P<0.05),and perforation rate tended to be higher in failure group compared to successful group(1.89%vs.0.37%,P=0.19).Composite endpoint of all-cause death and myocardial infarction at 5 year was not statistically different(6.45%vs.11.74%,P>0.05).Secondary endpoints including all cause-death(0.37%vs.1.89%)and myocardial infarction(1.49%vs.0.94%)at 30 days post procedure were similar between two groups(all P>0.05);TLR rate(18.28%vs.9.72%,P=0.03)w

关 键 词：左回旋支 慢性完全闭塞性病变 经皮冠状动脉介入治疗 预后 

分 类 号：R54[医药卫生—心血管疾病]