无心肌梗死病史慢性完全闭塞病变冠心病患者的临床特征

Clinical characteristics of coronary chronic total occlusion in patients without myocardial infarction

目的总结并探讨无心肌梗死(MI)病史的冠状动脉慢性完全闭塞病变(CTO)冠心病患者的临床、影像学和经皮冠状动脉介入治疗(PCI)的特点。方法纳入1995年7月至2014年12月在沈阳军区总医院心内科行PCI的连续性绝对性CTO冠心病患者共2651例,其中无MI病史患者1466例(55.3%,无MI组),有MI病史患者1185例(44.7%,MI组)。结果无MI组患者年龄、女性比例、不稳定型心绞痛比例、高血压病比例、血清三酰甘油水平及左心室射血分数(LVEF)均显著高于MI组,差异均有统计学意义(均P<0.05);而无MI组患者心力衰竭比例和血肌酸酐水平均显著低于MI组,差异均有统计学意义(均P<0.001)。无MI组患者多支病变比例(81.4%比76.5%,P=0.002)高于MI组;在CTO靶血管分布方面,无MI组患者左前降支比例(36.2%比40.7%,P=0.007)显著低于MI组,而左回旋支比例(17.0%比12.7%,P<0.001)、侧支循环良好比例(32.7%比27.0%,P<0.001)显著高于MI组,差异均有统计学意义。两组患者CTO靶血管PCI成功率、完全血运重建比例、平均支架置入数、平均支架直径和平均支架总长度比较,差异均无统计学意义(均P>0.05)。结论无MI病史的CTO冠心病患者因为年龄、性别、不稳定型心绞痛反复缺血预适应、高血压病等因素,可能促进了侧支循环的建立,使心功能得到保护。

Objective To analyze the clinical,imaging and interventional data of patients with chronic total occlusion（ CTO） lesions without myocardial infarction（ MI） and to summarize the clinical and imaging characteristics of these patients. Methods The data of 2651 patients with CTO verified by coronary angiography between January 1995 and December 2014 were analyzed retrospectively. Results There were1466 CTO patients（ 55. 3%） without MI（ the control group） and 1185 CTO patients（ 44. 7%） with MI（ the MI group）. The age,percentage of female patients,unstable angina,hypertention,mean triglyceride levels,left ventricular ejection fraction（ LVEF） were lower in the MI group than in the control group（ all P〈0. 05）. The rates of heart failure and serum creatinine levels were higher in the MI group than the control group（ both P〈0. 05）. The rate of multi-vessel disease was higher in the control group than in the MI group（ 81. 4% vs. 76. 5%,P〈0. 05）. According to the target CTO vessel location,patients in the control group had lower rates of CTO in LAD（ 36. 2% vs. 40. 7%,P = 0. 007） and higher rates of CTO in LCX（ 17. 0%vs. 12. 7%,P〈0. 001）. Patients in the control group without MI had better collateral circulation than that in the control group（ 32. 7% vs. 27. 0%,P〈0. 001）. There were no differences in success rate of PCI and complete revascularization between the two groups. Conclusions The present study showed that the CTO patients without MI were associated with better collateral development compared with the CTO patients with MI. Age,gender,unstable angina encouraging ischemic preconditioning and hypertension may be beneficial by facilitating collateral development through endogenous cardioprotective mechanisms.