我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

成功开通慢性完全闭塞冠状动脉病变血管能提高患者的生存率

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第6期
页码:
685-688
栏目:
临床研究
出版日期:
2013-11-25

文章信息/Info

Title:
Successful recanalization of chronic total occlusions improves longterm survival
作者:
林晓强; 朱 海; 詹源胜
(北海市人民医院心内科，广西 北海 536000)
Author(s):
LIN Xiao qiang;  ZHU Hai;  ZHAN Yuan sheng
(Department of Cardiology, Beihai People's Hospital, Beihai 536000, Guangxi, China)
关键词:
慢性完全闭塞; 药物洗脱支架; 长期预后; 经皮冠状动脉介入治疗
Keywords:
chronic total occlusions;  drugeluting stent(s);  longterm outcomes;  percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:观察慢性完全闭塞病变（chronic total occlusion，CTO）患者经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）成功对2年生存率的影响。方法： 连续入选2005年1月~2010年9月在我院心内科住院共700例稳定型心绞痛患者,其中84例（12%）为CTO患者。按照CTO病变成功开通组（开通组）或未成功开通组（未开通组）分层观察患者2年生存率。住院期间主要不良心脏事件（MACE）发生率，MACE包括心肌梗死、紧急血运重建、卒中或死亡。结果： 未开通组先前进行血运重建治疗的患者比例显著大于开通组（PCI分别为36% vs. 21%，P<0.01），两组的其他基线特征相似。术中并发症（包括冠状动脉夹层）在未开通组患者中更常见（分别为30.8% vs. 10.3%；P<0.05），但没有影响院内MACE事件发生率（分别为3%和2%,P>0.05）。开通组2年生存率显著高于未开通组（96% vs. 83%，P<0.01）。多因素分析显示手术成功为死亡概率的独立预测因子（HR：0.32,95% CI：0.18-0.58，P<0.01）。结论:CTO病变PCI术后开通组的2年生存率较未开通组显著提高。
Abstract:
AIM:To study the effect of successful percutaneous coronary intervention (PCI) on the mortality rate in patients with chronic total occlusion (CTO). METHODS: Eightyfour CTO cases (12%) of the 700 patients who underswent elective PCI for stable angina at our hospital from 2005 to 2010 were included in this study. CTO patients were divided into successful chronic total occlusion recanalization group (sCTO) and unsuccessful chronic total occlusion (uCTO) recanalization group and the 2year allcause mortalities were obtained (median: 1.8 years; interquartile range: 1.0 to 24 years) and stratified. Major adverse cardiac events (MACE) included myocardial infarction (MI), urgent revascularization, stroke, or death. RESULTS: A total of 58 (690%) procedures were successful and stents were implanted in 97.0% of the successful procedures (mean: 2.3±0.1) stents per patient, 73% drugeluting). Prior revascularization was more frequent in uCTO patients: PCI (36% vs. 21%; P<0.01). Baseline characteristics were otherwise similar. Intraprocedural complications including coronary dissection were more frequent in unsuccessful cases (30.8% vs. 10.3%; P<0.05) but did not affect inhospital MACE (3% vs. 2%; p=NS). The 2year allcause mortality was 17% for uCTO and 4% for sCTO (P<0.01). Multivariate analysis demonstrated that procedural success was independently predictive of mortality ［hazard ratio (HR): 0.32, 95% confidence interval (CI): 0.18 to 0.58］. CONCLUSION: Successful PCI for CTO patients increases their 2year survival rate. Application of new techniques and technologies to improve the procedural success may improve the prognosis.

参考文献/References

[1]Christofferson RD,Lehmann KG,Martin GV,et al.Effect of chronic total coronary occlusion on treatment strategy[J].Am J Cardiol,2005,95(9):1088 -1091.
[2]Cohen HA,Williams DO,Holmes DR,et al.Impact of age on procedural and 1year outcome in percutaneous transluminal coronary angioplasty: a report from the NHLBI dynamic registry[J].Am Heart J,2003,146(3):513-519.
[3]Grantham JA,Marso SP,Spertus J,et al.Chronic total occlusion angioplasty in the United States[J].J Am Coll Cardiol Intv,2009,2(6):479-486.
[4]Bell MR,Berger PB,Menke KK,et al. Balloon angioplasty of chronic total coronary artery occlusions: what does it cost in radiation exposure, time, and materials?[J].Cathet Cardiovasc Diagn,1992,25(1):10-15.
[5]Suzuki S, Furui S,Kohtake H,et al.Radiation exposure to patient’s skin during percutaneous coronary intervention for various lesions, including chronic total occlusion[J].Circ J,2006,70(1):44-48.
[6]Srinivas VS,Brooks MM,Detre KM,et al.Contemporary percutaneous coronary intervention versus balloon angioplasty for multivessel coronary artery disease:a comparison of the National Heart,Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) study[J].Circulation,2002,106(13):1627-1633.
[7]Joyal D,Afilalo J,Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and metaanalysis[J].Am Heart J,2010,160(1):179-187.
[8]Olivari Z,Rubartelli P,Piscione F,et al.Immediate results and oneyear clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOASTGISE)[J].J Am Coll Cardiol,2003,41(10):1672-1678.
[9]Sirnes PA,Myreng Y,M?lstad P,et al.Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions[J].Eur Heart J,1998,19(2):273-281.
[10]Lee SW,Lee JY,Park DW,et al.Longterm clinical outcomes of successful versus unsuccessful revascularization with drugeluting stents for true chronic total occlusion[J].Catheter Cardiovasc Interv,2011,78(3):346-353.
[11]Prasad A,Rihal CS,Lennon RJ,et al.Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic[J].J Am Coll Cardiol,2007,49(15):1611-1618.
[12]Mehran R,Claessen BE,Godino C,et al.for the Multinational Chronic Total Occlusion Registry.Longterm outcome of percutaneous coronary intervention for chronic total occlusions[J].J Am Coll Cardiol Interv,2011,4(9):952-961.
[13]Stone GW,Kandzari DE,Mehran R,et al.Percutaneous recanalisation of chronically occluded coronary arteries:a consensus document:part I[J].Circulation,2005,112(15):2364-2372.
[14]Hoye A,van Domburg RT,Sonnenschein K,et al.Percutaneous coronary intervention for chronic total occlusions:the Thoraxcenter experience 1992-2002[J].Eur Heart J,2005,26(24):2630-2636.
[15]Huber MS,Mooney JF,Madison J,et al.Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty[J].Am J Cardiol,1991,68(5):467-471.
[16]D’Agostino RB.Statistical primer for cardiovascular research: propensity scores in cardiovascular research[J].Circulation,2007,115(17):2340-2343.
[17]De Felice F,Fiorilli R,Parma A,et al. 3-year clinical outcome of patients with chronic total occlusion treated with drug-eluting stents[J].J Am Coll Cardiol Intv,2009,2(12):1260-1265.
[18]Shen ZJ,GarcíaGarcía HM,Garg S,et al.Fiveyear clinical outcomes after coronary stenting of chronic total occlusion using sirolimuseluting stents:insights from the rapamycineluting stent evaluated at Rotterdam Cardiology Hospital (Research) Registry[J].Catheter Cardiovasc Interv,2009,74(7):979-986.
[19]Suero JA,Marso SP,Jones PG,et al.Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries:a20-year experience[J].J Am Coll Cardiol,2001,38(2):409-414.
[20]Rathore S,Katoh O,Matsuo H,et al.Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice[J].Circ Cardiovasc Interv,2009,2(2):124-132.
[21]Thompson CA,Jayne JE,Robb JF,et al.Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions: an early U.S. experience[J].J Am Coll Cardiol Interv,2009,2(9):834-842.
[22]Sianos G,Barlis P, Di Mario C,et al.European experience with the retrograde approach for the recanalisation of coronary artery chronic total occlusions. A report on behalf of the EuroCTO club[J].EuroIntervention,2008,4(1):84-92.
[23]Morino Y,Kimura T,Hayashi Y,et al.Inhospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion: insights from the JCTO Registry (Multicenter CTO Registry in Japan)[J].J Am Coll Cardiol Intv,2010,3(2):143-151.
[24]Thompson CA.Percutaneous revascularization of coronary chronic total occlusions:the new era begins[J].J Am Coll Cardiol Interv,2010,3(2):152-154.

备注/Memo

备注/Memo:
收稿日期：2013-04-29.作者简介：林晓强，副主任医师Email:lxq01971@126.com
更新日期/Last Update: 2013-11-20