冠心病合并外周动脉粥样硬化病变联合介入治疗的疗效评价

Evaluation on the outcome of combined interventional therapies of coronary artery disease complicated with peripheral atherosclerosis disease

目的探讨冠心病合并外周动脉粥样硬化病变的患者行冠状动脉介入治疗(PCI)和外周动脉介入治疗(PPI)联合介入治疗的疗效和安全性。方法 2000年1月—2009年12月共284例接受联合介入治疗的冠心病合并外周动脉粥样硬化病变的住院患者,根据患者临床和病变严重程度及耐受程度同次或分次完成PCI和PPI。观察介入治疗手术相关并发症,住院期及随访期死亡及其死因、主要不良心脏事件率、血管造影复查再狭窄率等。结果 284例患者中≥2支冠状动脉病变180例(占63.4%),靶病变平均狭窄(85.0±10.9)%,共对459支靶冠状动脉的484处靶病变行PCI,共置入585枚冠状动脉支架,平均(2.06±0.83)枚/人。PCI即刻成功率100%,术后心绞痛完全缓解率99.3%(282/284)。合并2～3处外周动脉粥样硬化靶病变78例(占27.5%)。PPI靶病变平均狭窄(85.0±10.5)%,共治疗靶病变372处,共置入449枚外周动脉支架,平均(1.58±0.52)枚/人。204例与PCI同台完成PPI(占71.8%),PPI即刻成功率为99.7%,成功患者外周动脉病变患者术前存在的相关缺血临床表现完全缓解。介入手术相关并发症发生率为2.1%(6/284),1例PCI术中冠脉螺旋撕裂、股动脉穿刺局部较大血肿1例、假性动脉瘤1例、肾周围血肿1例,对比剂肾病2例,均经治疗恢复正常)。住院期间无死亡、急性心肌梗死、支架内血栓形成、严重肾功不全等发生。平均随访(58±46)个月,随访率98.6%(280/284),血管造影复查率63.9%(179/280),冠状动脉造影复查再狭窄率1.1%(2/179),外周动脉造影复查再狭窄率9.5%(17/179),全因死亡率为3.6%(10/280),心源性死亡率为1.4%(4/280),主要不良心脏事件率为2.5%(7/280)。无支架内血栓形成、严重肾功不全、截肢及行外科血管旁路移植术患者。结论冠心病合并外周动脉粥样硬化病变患者,单行PCI或PPI不能明显改善其生活质量。联合行PCI和PPI安全可行,近、远期疗效好,并发症发生率低。PCI和PPI可同次或分次完成,但首次介入治疗应完成主要罪犯冠状动脉的PCI,以保证患者安全并提高对PPI治疗的耐受性。

Objective To investigate the effectiveness and safety of combined therapies for patients with coronary artery disease（CAD） complicated with peripheral artery stenosis caused by atherosclerosis by means of percutaneous coronary intervention（PCI） and percutaneous peripheral intervention（PPI）.Methods From January 2000 to December 2009,a total of 284 in-hospital patients with CAD complicated with peripheral atherosclerotic stenosis were treated by combined therapies of PCI with PPI.PCI and PPI were carried out at together during the same procedure or might carried out as staged procedures in accordance with the clinical manifestation,the lesion severity and the tolerance of an individual patient.The acute and long-term outcome were evaluated.Results Among the 284 patients,180 patients had multi-vessel CAD（63.4%）.The mean narrowing rate of PCI target lesions was（85.0±10.9）%.The total 484 target lesions in 459 target coronary arteries and 585 coronary stents were implanted,mean implanted coronary stents were（2.06±0.83） per person.The immediately success rate of PCI procedure was 100%.The recovery rate of angina after PCI was 99.3%（282/284,only 2 patients had mild angina）.Seventy-eight patients had 2-3 peripheral atherosclerosis lesions.The mean narrowing rate of PPI target lesions was（85.0±10.5）%.A total of 449 peripheral stents were implanted in 372 target vessels,mean implanted peripheral stents were（1.58±0.52） per person.The PPI for 204 patients was finished during the same procedure of PCI（71.2%）。The immediately success rate of PPI procedures also achieved 99.7%.The relative ischemic symptoms for all patients with peripheral artery disease recovered.The procedure related total complications rate was 2.1%（6/284,one patients with coronary artery spiral dissection during PCI,one patient with larger hematoma and one with pseudo-aneurysm in femoral puncture site,one with hematoma around kidney,2 patients with contrast-Induced nephropathy,The all patients were recovered after successful management）.There severe complication such as death,acute myocardial infarction,thrombosis in stent and functional failure in kidney were not happened.Mean follow-up duration was 58±46 months.Rate of total follow-up was 98.6%（280/284）.Rate of angiographic follow-up was 63.9%（179/280）.Rate of coronary angiographic restenosis was 1.1%（2/179）.Rate of peripheral artery angiographic restenosis was 9.5%（17/179）.Rate of all death was 3.6%（10/280）.Rate of cardiac death was 1.4%（4/280）and Rate of major adverse cardiac events rate was 2.5%（7/280）.Complications including death,in-stent thrombosis,renal function impairment,leg amputated and artery by-pass grafting did not happened.Conclusions Patients with CAD complicated with peripheral atherosclerosis diseases received eigher PCI or PPI solely cannot improve their life quality.The combination treatment regimen of PCI with PPI for patients with lesions in coronary and peripheral artery is safe,feasible and can get good in-hospital effects and long-term clinical outcomes with lower complications.PCI and PPI can be carried out in same or staged procedure,but PCI for main target coronary artery should be finished in the first intervention in order to increase the patient safety and tolerance for PPI procedure.