多支慢性完全闭塞冠脉病变患者临床及冠脉造影特征

Clinical and imaging characteristics of patients with multi-vessel coronary chronic total occlusion

目的通过对冠脉造影发现的多支冠脉慢性完全闭塞(CTO)患者的临床和影像资料进行回顾性分析,总结多支CTO患者的临床和影像学特点。方法选取2004年1月至2005年12月诊断冠心病的连续住院患者,入院后行常规实验室生化检查及临床辅助检查,并行冠脉造影及左室造影检查。结果经冠脉造影证实有1支以上CTO病变的患者共513例,分成多支CTO组102例,单支CTO(对照)组411例。多支CTO患者中心律失常及心力衰竭患者比例较对照组高(P<0.05),而年龄和男性、吸烟史、并发高血压、糖尿病、脑血管病史的比例两组间无显著差异。多支CTO患者三酰甘油(TG)和纤维蛋白原水平高于对照组,而高密度脂蛋白(HDL)低于对照组(P<0.05);心脏超声左室较对照组扩大,而左室射血分数值低于对照组(P<0.05);肾功、胆固醇和血糖水平两组无显著差异。多支CTO患者绝对性CTO、长度≥15 mm CTO、直径≤2.5 mm CTO及桥侧支CTO占各组CTO血管总数的比例均高于对照组(P<0.05);两组刀切状CTO的比例无统计学差异。结论多支CTO患者临床病情较重,心功能较差,冠脉病变更加严重和复杂,这些临床及影像学特征可能增加CTO病变行经皮冠脉介入治疗的难度,对成功率有一定影响。

AIM To sum up the clinical and imaging characteristics by analyzing the clinical and imaging features of patients undergoing coronary angiography with multi-vessel chronic total occlusion （ CTO ） lesions from 2004 year to 2005. METHODS The data, from the patients with CTO who were verified by coronary angiography, were analyzed retrospectively. After admission, the patients took routine laboratory tests, X-ray, echo cardiography, coronary and left ventricle angiography check. RESULTS There were 513 CTO patients including 102 multi-vessel CTO patients and 411 single-vessel CTO patients. The ratios of cardiac arrhythmia and heart failure in the multi-vessel CTO patients were higher than those in the control group （ P 〈 0.05 ）. The mean level of TG and Fg in the multi-vessel patients were higher than that in the control group （ P 〈 0.05 ）. The ratios of absolute occlusion, I〉 15 mm in length, ≤2.5 mm in diameter and bridging collaterals in the multi-vessel CTO patients were all higher than those in the control group （ P 〈 0.05 ）. CONCLUSION There were more severer conditions, high ratios of heart failure and more complex coronary lesions in the multi-vessel CTO patients. These clinical and imaging characteristics of the multi-vessel CTO may increase the difficulties of PCI and to some extent affect the success rate of PCI procedure.