冠状动脉闭塞病变的经皮冠状动脉腔内成形术成功率及其影响因素探讨

Success rate and influencing factors of coronary angioplasty in patients with total occlusions

目的 总结 1991年 10月至 1998年 4月间 6 1例患者 6 5支冠脉闭塞病变经皮冠状动脉腔内成形术 (PTCA)资料 ,探讨冠脉闭塞病变PTCA治疗的影响因素。方法 (1)病例及分组 :急性冠脉闭塞组 (急性组 ) :10例 10支闭塞冠脉 ,系急性心肌梗塞后 12小时内PTCA ;亚急性冠脉闭塞组 (亚急性组 ) :2 9例 2 9支闭塞冠脉 ,急性心肌梗塞后 4周PTCA ;慢性冠脉闭塞早期组 (慢性早期组 ) :9例10支闭塞冠脉 ,推算冠脉闭塞时间大于或等于 1个月但小于 3个月 ;慢性冠脉闭塞晚期组 (慢性晚期组 ) :13例 16支闭塞冠脉 ,推算冠脉闭塞时间大于 3个月。 (2 )分析方法 :PTCA的成功率及与冠脉闭塞时间和冠脉闭塞局部形态特征的关系。结果 (1) 6 1例患者PTCA后 6 5支闭塞血管经PTCA后 5 4支开通 ,病变成功率 83 1% ,病例成功率 85 2 % (5 2 6 1)。 (2 ) 4组病人的病变成功率分别为 :急性组10 0 % (10 10 ) ;亚急性组 96 6 % (2 8 2 9) ;慢性早期组 70 % (7 10 ) ;慢性晚期组 5 0 % (8 16 )。 (3)急性和亚急性组PTCA失败与病变形态无关 ,慢性组局部病变呈平齐截断或有桥连侧支者失败率高。结论 冠脉闭塞病变PTCA治疗是一相对安全和有效的方法 。

Objective To disscuss the success rate and its relative factors of coronary angioplasty (PTCA) of total occlusions in 61 patients from Oct 1991 to Apr 1998 Methods 61 patients were divided into 4 groups: acute total occlusion group: 10 cases with 10 occluded branch underwent PTCA within 12 hours after acute myocardial infarction; subacute occlusion group: 29 cases with 29 occluded branch underwent PTCA at 4 weeks after acute myocardial infarction; earlier chronic occlusion group: 9 cases with 10 occlusions underwent PTCA during “calculated” occluded time which was between 1 month and 3 months; later chronic occlusion group: 13 cases with 16 occlusions underwent PTCA after 3 months according to the “calculated” occluded time Results (1) 54 occluded branch were revascularized in 61 patients with 65 occlusions, the lesion success rate was 83 1% while the case success rate was 85 2% (52/61); (2) The lesion success rates of four groups were 100% (10/10) for acute occlusion group, 96 6% (28/29) for subacute occlusion group, 70% (7/10) for earlier chronic occlusion group and 50% (8/16) for later occlusion group respectively; (3) The lesion morphology didn′t attributed to the failure of PTCA in acute occlusion group and subacute occlusion group, but the failure rates were high when no entry port and bridging collaterals existed Conclusion The PTCA of chronic total occlusions was relatively safe and effective, the occluded time and lesion morphology were important factors that predicted angiographic and clinical success in angioplasty of chronic occlusion