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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2011年第3期

页码:

354-357

栏目:

临床研究

出版日期:

2011-05-12

文章信息/Info

Title:

One-year outcome of percutaneous coronary intervention in patients with chronic total occlusion

作者:

李红¹; 吕树铮¹; 柳弘¹; 苑飞¹; 高铸烨²; 金泽宁¹; 朱华刚¹

1.首都医科大学附属北京安贞医院心内科,北京 100029；2.中国中医科学院西苑医院心血管科,北京 100091

Author(s):

LI Hong¹;  LU Shu-zheng¹;  LIU Hong¹;  YUAN Fei¹;  GAO Zhu-ye²;  JIN Ze-ning¹;  ZHU Hua-gang¹

1.Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing Institute of Heart, Lung and Blood Vessel, Beijing, 100029, China; 2.Department of Cardiology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Med

关键词:

冠状动脉疾病; 慢性闭塞病变; 经皮冠脉介入治疗

Keywords:

coronary artery disease;  chronic total occlusion;  percutaneous coronary intervention

分类号:

R541.4

DOI:

-

文献标识码:

A

摘要:

目的:通过冠状动脉慢性闭塞病变(CTO)患者冠脉介入治疗(PCI)经验总结探讨开通CTO对于患者临床症状、左室功能、存活率和生活质量的影响。方法： 选择于心内科病房住院接受冠脉造影、其中至少1支冠脉主支血管为CTO并接受PCI的患者，根据PCI手术是否成功分为成功组和失败组。应用正向导丝技术处理病变。出院后1年对患者进行随访。评价的终点事件包括死亡、心肌梗死、中风、再次PCI治疗和冠状动脉旁路移植术(CABG)。对各项数据进行统计学分析。结果： 434名入选患者，CTO介入治疗成功316名，失败118名。PCI失败组患者既往接受PCI手术(P<0.01)或CABG术(P<0.01)显著高于PCI成功组，高龄和吸烟比例也显著高于PCI成功组。两组患者在高血压病、高血脂、陈旧心梗及糖尿病等病史和心功能方面没有显著差别。PCI失败组两支CTO病变以及多支血管病变比率均显著高于PCI成功组患者(均P<0.01)。术后1年两组患者在死亡、心梗、中风和再次PCI方面没有显著差异，失败组患者心绞痛发生率高(P<0.01)，介入术后进行择期CABG手术比例高于成功组患者(P<0.01)。结论： 开通CTO可显著降低患者心绞痛和CABG手术率，而死亡、心梗、中风和再次PCI方面没有显著差异。

Abstract:

AIM:To investigate the effect of percutaneous coronary intervention (PCI) on clinical symptoms, left ventricular function, survival rate and quality of life in patients with at least one chronic total occlusion (CTO). METHODS: Patients admitted to the hospital from July 2007 to December 2008 and treated with PCI were included in the study when coronary angiography showed at least one main coronary artery occlusion. Patients were divided into PCI-success group or PCI-failure group according to the PCI results of occluded vessels. Anterograde approach and dedicated coronary wires were applied in the intervention operation. Patients were followed up at 1 year after PCI. Statistical differences of death, myocardial infarction, stroke, re-PCI and CABG between groups were evaluated. RESULTS: From July 2007 to December 2008, among the 1490 patients with abnormal coronary angiography results, 434 patients underwent PCI for at least one CTO. Of the 434 cases, the occluded vessels were treated successfully in 316 patients (72.8%). In the PCI-failure group, the average age was higher and more patients had a smoking history. Ratios of prior revascularization or coronary artery bypass graft (CABG) history in PCI-failure group were significantly higher than in PCI-success group. No obvious differences were observed in hypertension, hyperlipidemia, previous myocardial infarction, diabetes mellitus and cardiac function between groups. More patients in PCI-failure group had two CTOs and multivessel lesions (P<0.01 & P<0.01, respectively). Angina pectoris and selective CABG operation were significantly higher in PCI-failure group than those in PCI-success group (P<0.01 & P<0.01, respectively). No obvious differences between groups were seen in the death rate, myocardial infarction, stroke and re-PCI. CONCLUSION: Successful PCI therapy of CTO reduces rates of recurrence of angina pectoris and CABG operation, but no significant differences were found in the rates of death, myocardial infarction, stroke and re-PCI.

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备注/Memo

备注/Memo:

收稿日期：2010-08-10.通讯作者：吕树铮,主任医师,主要从事冠脉介入治疗的研究Email:shuzheng@medmail.com.cn 作者简介：李红,主治医师,博士Email:dr_lihong@hotmail.com

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更新日期/Last Update: 2011-03-17