介入治疗开通慢性完全闭塞病变的长期临床疗效

Long-term clinical outcomes of patients undergoing successful or failed percutaneous coronary intervention for chronic total occlusions of coronary arteries

目的评价经皮冠状动脉介入治疗（PCI）成功开通冠状动脉慢性完全闭塞（CTO）病变对长期临床疗效的影响。方法对1993年6月至2006年12月连续1332例冠状动脉CTO住院患者的临床资料进行分析。根据PCI结果将患者分为成功组（n=1202）和失败组（n=130），对比两组患者长期生存率、无主要不良心血管事件生存率及接受冠状动脉旁路移植术（CABG）的差别。结果总病例成功率为90．2％（1202／1332），成功组患者PCI后10年生存率、无主要不良心血管事件生存率均明显高于失败组（分别为76．9％比64．6％，log rank P=0．012；41．8％比27．6％，log rank P〈0．001），接受CABG患者则显著少于失败组（4．3％比14．6％，P〈0．001）。结论PCI开通CTO病变可明显提高患者长期生存率和无主要不良心脏事件生存率，并减少对CABG的需求。

Objective To evaluate the long-term outcomes of successful or failed revascularization in patients with chronic total occlusions （CTO）. Methods The clinical data of 1332 consecutive patients underwent percutaneous coronary intervention （PCI） for CTO between June 1993 and December 2006 in our hospital were analyzed. These patients were divided into two groups according to the procedural success （n = 1202） or failure （n = 130）. Results Overall success rate of procedure was 90. 2% （ 1202/1332）. The patients in CTO success group experienced a superior 10-year survival rate （76.9% vs. 64. 6% , log rank P = 0. 012 ） and a significantly higher no major adverse cardiovascular event （MACE） survival rate （41.8 % vs. 27. 6% , log rank P 〈 0. 001 ） compared to the patients in CTO failure group. During the long-term follow-up, the proportion of patients who accepted coronary artery bypass grafting（CABG） was significantly lower in CTO success group than that in the CTO failure group （4. 3% vs. 14. 6% ,P 〈0. 001 ）. Conclusion Successful PCI procedure leads to increased long-term survival and MACE-free survival and the reduced need for CABG for patients with CTO lesions.