药物洗脱支架对开通冠状动脉慢性完全闭塞病变患者预后的影响

The effect of successful percutaneous coronary intervention on the prognosis of patients with chronic total occlusion in drug-eluting stents era

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病变（CTO）,对患者长期预后的影响。方法：连续选取2010年1月至2012年1月,在首都医科大学附属北京安贞医院心内科一病房,经冠状动脉造影检查证实CTO病变,并PCI试行开通CTO病变患者为研究对象。记录患者临床资料、冠状动脉造影情况、手术并发症及PCI结果,根据手术是否成功分为PCI成功组（n=583）和PCI失败组（n=101）。院外随访入选患者,随访截止至2015年1月。随访主要终点事件为全因死亡率,次要终点事件为非致死性心肌梗死、再次血运重建及总MACE发生率,比较PCI成功组与失败组长期预后的差别。结果：研究共入选CTO患者684例,583例经PCI成功开通并置入药物涂层支架,开通率（85.2%）。随访时间4.6（3,5）年,其中成功开通CTO组失访60例（失访率10.3%）,失败组失访10例（失访率9.9%）。校正前PCI成功组总MACE（23.3%vs.48.5%,P〈0.05）、全因死亡率（5.2%vs.17.8%,P〈0.05）、TVR率（11.2%vs.21.8%,P〈0.05）低于失败组,非致死性MI发生率与失败组差异无统计学意义（7.0%vs.8.9%,P〉0.05）。Cox模型多因素分析显示,PCI成功组总MACE发生率（HR：1.421,95%CI：1.079~1.870）、全因死亡率（HR：0.324,95%CI：0.165~0.637）、TVR率（HR：2.077,95%CI：1.459~2.761）仍明显低于失败组（P〈0.05）。结论：对慢性闭塞病变行成功的PCI术,可以降低全因死亡率和再次血运重建率,降低MACE的发生率,改善患者长期预后。

Objective： This study investigated the clinical outcomes after Percutaneous coronary intervention（ PCI） for Chronic Total Occlusion（ CTO）. Methods： The CTO patients who underwent PCI in Beijing Anzhen Hospital NO. 1 ward from January 2010 to January 2012 were included in this study. The clinical data,coronary angiography characteristics,the complications of PCI and the outcomes were recorded. The patients were devided into two groups according to the results of PCI： successful PCI of CTO（ s CTO,n = 583） group and unsuccessful PCI of CTO（ u CTO n = 101） group. Follow up the patients to January 2015,all-cause mortality,nonfatal myocardial infarction and revascularization were recorded and compared between the two groups.Results： A total of 684 patients who underwent PCI were included in this study. Stents were successfully implanted in 583 patients（ 85. 23%）. Follow up 3-5 years,the loss of follow up in s CTO were 60 patients（ 10. 29%）,the loss of follow up in u CTO were 10 patients（ 9. 9%）. Before regression adjustment the total MACE was 48. 51% for u CTO and 23. 33% for s CTO（ P〈0. 05）,all-cause mortality was 17. 82% for u CTO and 5. 15% for s CTO（ P〈0. 05）,TVR was 21. 78% for u CTO and 11. 15% for s CTO（ P〈0. 05）,nonfatal myocardial infarction was 8. 91% for u CTO and 7. 03% for s CTO（ P〉0. 05）. After regression adjustment by Cox analysis,the total MACE（ HR： 1. 421,95% CI1. ： 079-1. 870）,all-cause mortality（ HR： 0. 324,95% CI：0. 165-0. 637） and TVR（ HR： 2. 077,95% CI1. 459-2. 761） are remarkable lower for s CTO than u CTO group.Conclusions： Successful PCI for CTO can improve the prognosis and reduce the all-cause mortality,TVR and MACE.