摘要
目的 探讨不同时间窗经皮冠状动脉介入治疗（PCI）开通冠状动脉完全闭塞病变的临床特点,评价其对远期预后的影响。方法 连续入组358例择期PCI治疗的冠状动脉完全闭塞病变患者,分为非慢性完全闭塞（non-CTO）组（闭塞时间2周-3个月,126例）和慢性完全闭塞（CTO）组（闭塞时间〉3个月,232例）。对两组基线临床资料、冠状动脉影像特征、PCI术中使用的技术及器械、术后1年主要不良心脏事件（MACE）的发生情况进行回顾性分析。结果 与non-CTO组比较,CTO组PCI治疗成功率低（75.4%比85.3%,χ^2=4.397,P=0.005）,但两组间并发症发生率差异无统计学意义（21.1%比19.0%,χ^2=0.216,P=0.642）。两组间在介入路径、指引导管直径选择及导丝、支架数目等方面差异无统计学意义,两组间造影剂使用量、介入手术时间比较差异有统计学意义（均为P〈0.05）,但在特殊器械及技术应用方面CTO组显著多于non-CTO组,如微导管的使用（47.4%比28.6%,χ^2=12.004,P〈0.001）、影像技术的支持（血管内超声或光学相干断层成像）（4.7%比0.8%,χ^2=3.928,P=0.047）、冠状动脉旋磨术的应用（5.6%比1.6%,χ^2=3.281,P=0.005）、对侧造影技术（38.4%比17.5%,χ^2=16.676,P〈0.001）及逆向导丝技术（5.6%比0,χ^2=7.326,P=0.007）的应用等。12个月的随访显示,CTO组总体MACE事件发生率低于non-CTO组（3.7%比16.0%,χ^2=7.084,P=0.008）。结论 PCI开通冠状动脉闭塞病变具有较高的成功率和安全性。PCI治疗CTO病变较开通闭塞时间〈3个月的闭塞病变需使用更多的特殊器械和专项技术,PCI治疗的成功率前者低于后者,但远期预后却优于后者。
Objective To investigate the clinical features of coronary chronic total occlusions （CTO） opened by percutaneous coronary intervention （PCI） in different time windows and evaluate long term outcomes of CTO treated in different time windows. Methods The 358 consecutive patients were enrolled in this study,who were divided into non-CTO group （ occlusive time from 2 weeks to 3 months,n=126） and CTO group （ occlusive time 〉 months, n =232 ） .Their baseline clinical characteristics, angiographic features,techniques and apparatus applied during procedure,incidence of major adverse cardiac events （ MACE） occurred in postoperative 1-year follow-up were analyzed. Results Compared with non-CTO group,success rate of PCI in CTO group was significantly lower （75.4% vs.85.3%,χ^2 =4.397,P=0.005）,but incidence of complications between the two groups was no difference （21.1%vs.19.0%,χ^2 =0.216,P=0.642）.There were no differences in PCI approach,size of guiding catheter,numbers of stents and guidewires.Dose of contrast agent and operative time was statically different （ P 〈0.05 ） .Special apparatus and technique were much more used in CTO group,such as microcatheter （47.4% vs.28.6%,χ^2 =12.004, P 〈0.001）, imaging technology, such as intravascular ultrasound （ IVUS） and optical coherence tomography （OCT） （4.7% vs.0.8%,χ^2 =3.928,P=0.047）,coronary rotational atherectomy （5.6% vs.1.6%,P=0.005）,contralateral angiography （38.4% vs.17.5%,P〈0.001） and retrograde wire technique （5.6%vs.0,χ^2 =3.281,P=0.007）.Incidence of MACE of 1-year follow-up postoperatively was lower in CTO group compared with non CTO group （3.7% vs.16.0%,χ^2 =7.084,P=0.008）. Conclusions PCI opens coronary occlusion with a higher success rate and safety.Compared to the lesions of non-CTO which occlusive time is less than 3 months, revascularization for CTO patients will need more special technique and apparatus.Successful rate of CTO by PCI is lower than non-CTO,but PCI treated CTO patients has a better long-term prognosis in 1-year follow-up than that of non-CTO patients.
作者
徐承义
曾秋棠
苏晞
宋丹
彭剑
鄢华
Xu Chengyi Zeng Qiutang Su Xi Song Dan Peng Jian Yan Hua(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022 , China Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 , China)
出处
《中国心血管杂志》
2016年第5期368-374,共7页
Chinese Journal of Cardiovascular Medicine
关键词
冠状动脉疾病
动脉硬化
闭塞性
血管成形术
经腔
经皮冠状动脉
回顾性研究
Coronary artery disease
Arteriosclerosis obliterans
Angioplasty,transluminal,percutaneous coronary
Retrospective studies
