慢性完全闭塞病变血运重建后围术期心肌梗死发生率及危险因素分析  

The prevalence and risk factors for periprocedural myocardial infarction after revascularization in chronic total occlusion

作　　者：刘严慈 彭红玉[1] 柳景华[1] 李文铮[1] 吴铮[1] 赵东晖[1] 程子超 LIU Yan-ci;PENG Hong-yu;LIU Jing-hua;LI Wen-zheng;WU Zheng;ZHAO Dong-hui;CHENG Zi-chao(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冠心病中心,北京100029

出　　处：《中国介入心脏病学杂志》2022年第8期573-579,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的 采用慢性完全闭塞病变学术联盟(CTO-ARC)专家共识定义,按照CTOARC围术期心肌梗死(PMI)标准,评价慢性完全闭塞(CTO)病变行经皮冠状动脉介入治疗(PCI)PMI的发生率,并对相关危险因素进行分析。方法 根据CTO-ARC标准,回顾性分析首都医科大学附属北京安贞医院冠心病中心自2019年1—6月所有通过PCI成功完成血运重建的CTO病变患者的临床基线特征、造影结果以及手术操作特点,应用多因素Logistic回归分析识别PMI的独立危险因素。结果 纳入通过PCI成功完成血运重建的CTO病变415例,PMI发生率4.8%。经多因素Logistic回归分析,供血血管闭塞(OR 48.818,95%CI 2.365~1 007.888,P=0.012)、边支血管损伤(OR 20.332,95%CI 4.439~93.132,P<0.01)、术后心肌梗死溶栓治疗试验(TIMI)血流分级<Ⅲ级(OR 33.310,95%CI6.209~178.689,P<0.01)及支架长度(OR 1.020,95%CI1.005~1.035,P=0.011)与CTO病变血运重建后PMI密切相关。结论 供血血管闭塞、边支血管损伤、术后TIMI血流分级<Ⅲ级及支架长度与CTO病变血运重建后PMI密切相关。Objective To investigate the prevalence and risk factors for periprocedural myocardial infarction(PMI) after percutaneous coronary intervention(PCI) in patients with chronic coronary total occlusion(CTO). Methods According to the diagnostic criteria for PMI based on CTO-ARC, CTO patients successfully revascularized through PCI from January 2019 to June 2019 in Beijing Anzhen Hospital was enrolled. The baseline clinical features,coronary angiography findings and PCI procedural process were analyzed. The independent risk factors for PMI occurrence were identified by multivariate Logistic regression analysis. Results A total of 415 CTO patients were included in the fi nal analysis. PMI occurred in 4.8% of all the procedures. Multivariate Logistic regression analysis presented that donner vessel occlusion(OR 48.818,95%CI 2.365–1 007.888,P=0.012), side branch injury(OR 20.332,95%CI 4.439–93.132,P<0.01),TIMI flow grade<3(OR 33.310,95%CI 6.209–178.689,P<0.01),and the length of stent(OR 1.020,95%CI 1.005–1.035,P=0.011)were associated to PMI occurrence. Conclusions Donner vessel occlusion, side branch injury, TIMI fl ow grade<3,and the length of stent are closely related to PMI occurrence.

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 围术期心肌梗死 

分 类 号：R541[医药卫生—心血管疾病]