成功经皮冠状动脉介入治疗对比药物治疗对不同左心室射血分数慢性完全性闭塞病变患者临床预后的影响  

The effect of successful percutaneous coronary intervention versus medical treatment on the chronic total occlusion with different left ventricular ejection fraction levels

作　　者：田晋帆 杨雪瑶 左惠娟[1] 张丽君[1] 宋现涛[1] TIAN Jinfan;YANG Xueyao;ZUO Huijuan;ZHANG Lijun;SONG Xiantao(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2021年第9期890-895,901,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展专项(2018-2-2063);2018年“冠状动脉微血管疾病创新基金(2018-CCA-CMVD-01)”;2018年“北京市优秀人才骨干”(2018000021469G241);2020年“北京市教育委员会科技计划项目”(KM202010025016);国家自然科学基金(82100486)。

摘　　要：目的:本研究旨在对比单纯药物治疗(MT)与经皮冠状动脉介入(PCI)治疗开通慢性完全闭塞(CTO)病变对不同LVEF患者临床预后的影响。方法:本研究回顾性纳入2014年12月至2020年12月,于北京安贞医院住院行冠状动脉造影证实存在一支血管CTO,且于造影前行心脏磁共振的患者219例。按照是LVEF是否>50%分为两组。对比药物治疗与成功开通CTO病变对患者不良心血管事件(MACE)及全因死亡率的影响,并分析药物治疗或成功开通CTO病变治疗前后心功能的变化。MACE定义为非计划性血运重建,非致死性心肌梗死,支架内再狭窄,心源性死亡,心力衰竭再住院的联合事件。结果:符合入组标准研究对象共219例,其中开通CTO病变145例,药物治疗74例。对于LVEF>50%组(n=150),成功开通CTO病变98例,药物治疗52例。在Cox多因素回归分析中,成功开通CTO病变与药物治疗MACE发生率(校正HR=0.89,95%CI:0.31~2.54,P=0.826)及全因死亡率(P=0.954)相当;开通CTO病变后LVEF[治疗后vs.治疗前:(62.43±8.24)%vs.(64.08±6.84)%,P=0.155]无显著变化。对于LVEF<50%组(n=69),成功开通CTO病变47例,药物治疗22例。在Cox多因素回归分析中,成功开通CTO病变与药物治疗MACE发生率(校正HR=0.84,95%CI:0.17-4.04,P=0.823)及全因死亡率(P=0.663)差异无统计学意义;开通CTO病变后LVEF显著增加[治疗后vs.治疗前:(48.39±13.75)%vs.(38.17±8.34)%,P=0.001]。结论:对于LVEF>50%或<50%的CTO患者,对比成功开通CTO病变,药物治疗并未增加患者MACE。对于LVEF<50%患者,成功开通CTO病变后显著提高患者LVEF。因此,对于LVEF<50%的患者,开通CTO病变存在潜在获益。Objective:The study was aimed to show the effect of medical treatment(MT)versus per-cutaneous coronary intervention(PCI)on chronic total occlusion(CTO)patients with different LVEF levels.Methods:From December 2014 to December 2020,219 patients with single CTO artery and CMR detection before Coronary angiography in Beijing Anzhen Hospital were retrospectively recruited.Patients were divided into two groups according to whether the LVEF was above 50%or not.The effect of CTO-PCI on major adverse cardiac event(MACE),mortality,and cardiac function were analyzed among patients with LVEF>50%or<50%.MACE was defined as a composition of un-planed revascularization,non-fatal myocardial infarction in stent restenosis,cardiac death and re-hospitalization for heart failure.Results:A total of 219 patients who met the inclusion criteria were included in the analysis.145 patients underwent successful CTO-PCI,and 74 patients had MT.The overall MACE rate was 14.6%(32/219)and all-cause mortality was 1.8%(4/219).Successful CTO-PCI did not affect the rate of MACE(log rank=0.298,P=0.585)and mortality(log rank=2.542,P=0.111).For patients with LVEF>50%(n=150),98 cases underwent successful CTO-PCI and 52 patients had MT.In Cox multivariate regression analysis,the incidence of MACE(adjusted HR=0.89,95%CI:0.31-2.54,P=0.826)and all-cause mortality(P=0.954)were similar between CTO-PCI group and MT group;LVEF(62.43±8.24)%vs.(64.08±6.84)%(P=0.155)was not affected by successful CTO-PCI.For patients with LVEF<50%(n=69),47 patients underwent successful CTO-PCI,and 22 patients had MT.In Cox multivariate regression analysis,the incidence of MACE(adjusted HR=0.84,95%CI:0.17-4.04,P=0.823)and mortality(P=0.663)were similar between the two groups.LVEF(48.39±13.75)%vs.(38.17±8.34)%(P=0.001)was improved by successful CTO-PCI.Conclusions:For the patients with LVEF>50%or<50%,compared to successful CTO-PCI,MT did not increase MACE.For patients with LVEF<50%,the LVEF was significantly improved by successful CTO-PCI.CTO-PCI potentially benefits pa-tients w

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 药物治疗 心功能 

分 类 号：R54[医药卫生—心血管疾病]