经皮冠状动脉介入治疗血运重建对冠状动脉慢性完全闭塞病变长期预后的影响:一项回顾性队列研究  

The eff ect of successful percutaneous coronary intervention on the long-term prognosis among patients with chronic total occlusion lesion:a retrospective cohort study

作　　者：田晋帆 左惠娟[2] 杨雪瑶 张丽君[3] 雍婧雯 邢浩然 张东凤[1] 张明多[1] 贺毅 宋现涛[1] TIAN Jin-fan;ZUO Hui-juan;YANG Xue-yao;ZHANG Li-jun;YONG Jing-wen;XING Hao-ran;ZHANG Dong-feng;ZHANG Ming-duo;HE Yi;SONG Xian-tao(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]北京市心肺血管疾病研究所人群防治研究室 [3]首都医科大学附属北京安贞医院影像科 [4]首都医科大学附属北京友谊医院影像科

出　　处：《中国介入心脏病学杂志》2022年第4期265-270,共6页Chinese Journal of Interventional Cardiology

基　　金：2018年冠状动脉微血管疾病创新基金项目(2018-CCA-CMVD-01);首都卫生发展专项项目(2018-2-2063);2018年北京市优秀人才骨干项目(2018000021469G241);2020年北京市教育委员会科技计划项目(KM202010025016)。

摘　　要：目的评价经皮冠状动脉介入治疗(PCI)开通慢性完全闭塞(CTO)病变对患者长期预后的影响。方法回顾性分析首都医科大学附属北京安贞医院2015年3月至2020年1月符合入组标准并完成第一阶段随访的270例CTO病变患者。结果纳入分析的研究对象共270例,平均年龄(57.2±10.7)岁,男212例。成功开通CTO病变患者185例,CTO病变未开通患者85例(56例患者CTO病变开通失败,29例患者初始选择优化药物治疗)。中位随访时间26.3个月。单支血管CTO病变患者153例,平均年龄(56.2±10.7)岁,男127例。成功开通CTO病变组102例,CTO病变未开通51例(CTO病变开通失败组30例,初始优化药物治疗组21例)。CTO病变开通失败组既往PCI比例高于成功开通CTO病变组(53.3%比27.5%,P=0.008)。单支血管CTO合并多支血管病变患者117例,平均年龄(58.4±10.7)岁,男85例。成功开通CTO病变组83例,CTO病变未开通34例(CTO病变开通失败组26例,初始优化药物治疗组8例)。对于单支血管CTO病变患者,Cox多因素回归分析显示,与成功开通CTO病变相比,CTO病变开通失败不影响患者长期主要不良心血管事件(MACE)发生率(HR0.442,95%CI 0.096~2.048,P=0.297)及全因死亡率(HR 1.882,95%CI 0.113~31.415,P=0.660),此外初始优化药物治疗不影响患者MACE发生率(HR 2.139,95%CI 0.660~6.937,P=0.205)及全因死亡率(HR 9.423,95%CI 0.325~273.251,P=0.192)。对于单支血管CTO合并多支血管病变患者,Cox多因素回归分析显示,与成功开通CTO病变相比,CTO病变开通失败(HR 0.151,95%CI0.020~1.132,P=0.066)或初始优化药物治疗(HR 1.365,95%CI 0.303~6.147,P=0.685)不影响患者长期MACE发生率。结论对于仅存在单支血管CTO病变的患者,或单支血管CTO合并多支血管病变的患者,CTO病变开通失败或仅优化药物治疗未增加MACE发生率和全因死亡率。Objective To investigate the effect of percutaneous coronary intervention(PCI)on the long-term prognosis of chronic total occlusion(CTO)patients.Methods We retrospectively analysis 270 CTO patients in our hospital from March 2015 to January 2020 who met the inclusive criterion and were followed up in the first period.Results A total of 270 patients were enrolled,with a mean age of(57.2±10.7)years old and 212 males,including 185 patients of successful CTO-PCI and 85 patients of failed CTO-PCI[(56 cases with failed CTO-PCI and 29 cases with initially optimal medical therapy(OMT)only)].The median follow-up time was 26.3 months.The subjects were divided into single-vessel CTO group and single vessel CTO combined with multi-vessel disease(MVD)group,according to whether they were combined with MVD or not.There were 153 cases with single-vessel CTO.In the single-vessel CTO group,102 cases have successful CTO-PCI,30 cases were failed to open the CTO lesion,and 21 cases initially choose OMT.Multivariate Cox regression analysis showed that compared to successful CTO-PCI,failed CTO-PCI[(HR 0.442,95%CI 0.096–2.048,P=0.297)and(HR1.882,95%CI 0.113–31.415,P=0.660)]and initial OMT[(HR 2.139,95%CI 0.660–6.937,P=0.205)and(HR 9.423,95%CI 0.325–273.251,P=0.192)]did not increase MACE and all-cause mortality,respectively.In the single-vessel combined with MVD group,multivariate Cox regression showed that compared to successful CTO-PCI,failed CTO-PCI(HR 0.151,95%CI0.020–1.132,P=0.066)and initial OMT(HR 1.365,95%CI 0.303–6.147,P=0.685)did not affect MACE.Conclusions For patients with single-vessel CTO or single-vessel CTO combined with MVD,failed to open CTO lesion or initial OMT did not increase long-term MACE and all-cause mortality.

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 优化药物治疗 

分 类 号：R541[医药卫生—心血管疾病]