2型糖尿病合并冠状动脉慢性完全闭塞病变围手术期心肌损伤预测因素分析

Analysis on predictive factors of periprocedural myocardial injury for type 2 diabetes patients with chronic total occlusion

目的:从临床、检验及影像学特点等方面,探讨2型糖尿病患者冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)经皮冠状动脉介入治疗围手术期心肌损伤(peri-procedure myocardial injury,PMI)的预测因素分析。方法:收集复旦大学附属中山医院心脏介入中心专用数据库2013年1月至2014年12月临床诊断"冠心病"收入院的患者,选择2型糖尿病合并CTO病变患者134例。结果:研究入选134例2型糖尿病合并CTO病变患者,平均年龄(62.12±9.018)岁,其中男性占81.34%(109/134),PMI发生率为14.18%(19/134),根据是否发生围手术期心肌损伤分为围手术期心肌损伤组(19人)和围手术期非心肌损伤组(115人)。单因素分析发现:两组间开口病变、钝性残端病变、扭曲病变、病变长度>20mm、逆向导丝技术、反向CART技术、J-CTO积分均具有明显差异。Logistic多元回归分析显示:反向CART技术(OR 7.580,P<0.05)、病变长度>20mm(OR 3.642,P<0.05)是2型糖尿病患者合并CTO病变引起围手术期PMI的独立预测因素。结论:反向CART技术、病变长度>20mm是2型糖尿病合并CTO病变发生PMI的独立预测因素。预知该类特殊患者围手术期心肌损伤的风险,对心脏不良事件进行评估,从而有助于治疗策略的选择。

Objective：To discuss the analysis on predictive factors of periprocedural myocardial inj ury （PMI）for type 2 diabetes patients with chronic total occlusion （CTO）from the pespective of clinical data,laboratory examination and imaging characteristics.Methods：Totally 134 cases with type II diabetes combined CTO in Zhongshan hospital of Fudan university heart intervention center database during January 2013 to December 2014 were selected.Results：In 134 cases with type 2 diabetes combined CTO,the average age was （62.12±9.018）,in which male accounted for 81.34%（109/134）.The incidence of PMI was 14.2% （19/134）.Patients wre divided into PMI group （n= 19）and non-PMI group （n= 115）according to the occurrence of perioperative myocardial inj ury.The single factor analysis showed that the significant differences of ostial occlusion ,blunt stump,severe tortuosity,longer CTO length〉20 mm,retrograde approach,Reverse CART approach,and J-CTO score between two groups.The Logistic multiple regression analysis showed that the Reverse CART approach （OR 7.580,P〈0.05）,occlusion length〉20 mm （OR 3.642,P〈0.05）were the independent predictor of PMI in type 2 diabetes patient with CTO.Conclusions：The Reverse CART technology,and occlusion length〉20 mm are the independent predictor of PMI of type 2 diabetes mellitus combined CTO.To predict the special risk for perioperative myocardial injury patients, assessment of adverse cardiac events iscontributing to the choice of treatment strategy.