慢性完全闭塞冠状动脉病变患者79例的介入治疗

Immediate and long-term effect of percutaneous coronary intervention in 79 patients with chronic total occlusion

目的:回顾分析慢性完全闭塞(CTO)冠状动脉病变实施经皮冠状动脉介入治疗(PCI)的临床资料,总结CTO病变特征、PCI的技术方法和近、远期疗效.方法: 对79例含有CTO病变的患者进行PCI治疗,共对98支CTO病变靶血管进行了PCI,CTO闭塞时间3～120(17.8±26.1)月,置入冠状动脉支架161枚.结果:共开通71例患者的CTO靶病变85处,术终达到TIMI 3级血流的病例成功率为89.9%(71/79),病变成功率为86.7%(85/98),完全血运重建率36.7%(29/79).其中CTO闭塞时间3～6个月及6个月以上者其PCI病变成功率分别为93.9%(62/66)和71.9%(23/32)(P＜0.05).有桥侧支存在者成功率低于无桥侧支者,56.3%(9/16)比93.9%(77/82)(P＜0.05).断端成刀切状成功率低于鼠尾状CTO,77.8%(14/18)比91.3%(21/23)(P＜0.05),闭塞段＞15mm的长CTO病变成功率低于短病变者,83.3%(55/66)比90.4%(30/32)(P＜0.05).随访患者78例(98.7%),随访时间4～48(16.7±10.9)个月,无事件生存率为79.7%,心脏不良事件(MACE)发生率为12.7%(10/79),血运重建率为8.9%(7/79).结论:影响成功率的因素有血管闭塞时间、闭塞长度、闭塞末端形态、桥状侧支等,成功PCI治疗可改善CTO患者的临床症状、生活质量及远期预后.

Objective:To investigate retrospectively the immediate and long-term effects of percutaneous coronary intervention(PCI),and the characteristics of chronic total occlusion(CTO).Methods:79 patients with CTO lesions and PCI were collected from Mar.2002 to Oct.2005.Totally 98 CTO lesions were performed with PCI;CTO lesions lasted from 3 to 120 months(17.8±26.1ms)and 161 stents were implanted.Results:85 CTO lesions in 71 patients were successfully opened and perfusion reached to TIMI 3 grade in 71 of 79(89.9%)patients,with successful rate of 86.7%.Complete revascularization up to 36.7% bere performed.The success rate of CTO with 3～6 or over 6 months was 93.9% and 71.9% respectively(P<0.05).The possibility of success in patients with collaterals was lower than without collaterals(56.3% Vs.93.9%,P<0.05),lower in patients with cutter-shape of CTO residual stem than with mouse-tail shape(77.8% Vs.91.3%,P<0.05),and lower in patients with long lesion(>15mm)of CTO than with short lesion(83.3% Vs.90.4%,P<0.05).PCI failed in 8 patients with CTO.No death occurre with procedure.78(98.7%)patients have been followed-up within 4 to 48 months(mean 16.7 ±10.9ms).The survival rate of free-of-events was 79.7% and the major adverse cardiac events(MACE)rate was 12.7%.revascularization rate was 8.9%.Conclusion:The factors that influence the success rate of PCI for CTO lesion include duration,length,shape of residual,collateral for occlusion vessel,etc.Successful PCI can improve clinical symptom,quality of life,immediate and long-term prognosis for patients with CTO lesion.