冠脉CTO行PCI失败与CCTA参数的相关性及联合CT衰减校正MPI的术前指导价值  

Correlation between PCI failure of coronary CTO and CCTA parameters and preoperative guiding value of combined CT attenuation corrected MPI

作　　者：李琰 郭洋洋 赵森[1] 杜森 周青[1] Li Yan;Guo Yangyang;Zhao Sen(Department of Medical Imaging,the First Affiliated Hospital of Henan University,Kaifeng 475004)

机构地区：[1]河南大学第一附属医院医学影像科,河南开封475004 [2]中国人民解放军联勤保障部队第九八八医院开封医疗区医学影像科,河南开封475004

出　　处：《中国现代医药杂志》2023年第2期15-19,共5页Modern Medicine Journal of China

基　　金：2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20210565)。

摘　　要：目的 探讨冠脉慢性完全闭塞(Chronic total coronary occlusion,CTO)病变行经皮冠脉介入(Percutaneous coronary intervention,PCI)治疗失败与冠脉CT血管成像(Coronary computed tomography angiography,CCTA)参数的相关性及联合CT衰减校正核素心肌灌注显像(Myocardial perfusion imaging,MPI)的术前诊断价值。方法 对2020年1月~2022年2月在我院治疗的冠心病患者进行回顾性分析,共185例。其中冠脉CTO患者58例,均在我院接受PCI治疗。统计冠脉CTO患者的临床资料、CCTA参数。分析CT衰减校正MPI联合CCTA术前诊断CTO的价值。结果 冠脉CTO行PCI失败患者年龄为(65.98±7.41)岁,明显高于PCI成功患者(P<0.05)。冠脉CTO行PCI失败患者闭塞形态呈钝形、血管弯曲>45°、有钙化、有负性重构、闭塞长度≥20mm、J-CTO评分≥2分比例分别为64.29%、78.57%、50.00%、64.29%、71.43%和78.57%,明显高于PCI成功患者(P<0.05)。闭塞形态、血管弯曲、钙化、闭塞长度及J-CTO评分是冠脉CTO患者行PCI失败的影响因素(P<0.05)。CCTA联合CT衰减校正MPI诊断冠脉CTO的灵敏性和阴性预测值分别为98.28%和99.16%,明显高于CCTA、CT衰减校正MPI单独诊断(P<0.05)。不同病变血管CTO患者中CCTA联合CT衰减校正MPI检出率比较差异无统计学意义(P>0.05)。结论 冠脉CTO患者行PCI效果受闭塞形态、血管弯曲等CCTA参数影响。CCTA联合CT衰减校正MPI有助于术前冠脉CTO的诊断。Objective To investigate the correlation between the failure of percutaneous coronary intervention(PCI) and coronary computed tomography angiography(CCTA) parameters for chronic total occlusion(CTO) lesions and the preoperative diagnostic value of combined CT attenuation correction for myocardial perfusion imaging(MPI).Methods A total of 185 patients with coronary heart disease treated in our hospital from Jan 2020 to Feb 2022were retrospectively analyzed. Among them, 58 CTO patients received PCI treatment in our hospital. The clinical data and CCTA parameters of patients who failed and succeeded in PCI were analyzed. At the same time, the value of CCTA combined with CT attenuation corrected MPI in preoperative diagnosis of CTO was analyzed. Results The age of patients with failed PCI on CTO was(65.98±7.41) years old, which was significantly higher than that of patients with successful PCI(P<0.05). The proportions of blunt shape, vessel curvature >45°, calcification, negative remodeling,occlusion length ≥ 20mm, and J-CTO score ≥ 2 points were 64.29%, 78.57%, 50.00%, 64.29%, 71.43% and 78.57%in patients with failed PCI, which were significantly higher than those of the patients with successful PCI(P<0.05).Occlusive form, vessel curvature, calcification, occlusion length and J-CTO score were the influencing factors of PCI failure in CTO patients(P<0.05). The sensitivity and negative predictive value of CCTA combined with CT attenuation corrected MPI in the diagnosis of CTO were 98.28% and 99.16%, respectively, which were significantly higher than those of CCTA and CT attenuation corrected MPI alone(P<0.05). There was no statistically significant difference in the detection rate of CCTA combined with CT attenuation correction MPI in patients with different vascular CTO(P>0.05). Conclusion The effect of PCI in coronary CTO patients is affected by CCTA parameters such as occlusion shape and vessel curvature. CCTA combined with CT attenuation corrected MPI is helpful for the diagnosis of preoperative coronary CTO

关 键 词：冠脉慢性完全闭塞病变 经皮冠脉介入 冠脉CT血管成像 CT衰减校正核素心肌灌注显像 

分 类 号：R541.4[医药卫生—心血管疾病]