不同时机经皮冠状动脉介入治疗对冠状动脉慢性完全闭塞病变患者影响的对比研究

Comparative Study for Impact on Patients with Coronary Artery Chronic Total Occlusion in Different Opportunities of PCI

目的比较不同时机经皮冠状动脉介入治疗(PCI)对冠状动脉慢性完全闭塞病变(CTO)患者的影响。方法选取2013年1月—2016年4月铜川矿务局中心医院收治的冠状动脉CTO患者132例,根据PCI时机分为A组70例和B组62例。A组患者于闭塞2~12周行PCI,B组患者于闭塞12周后行PCI。比较两组患者手术情况、特殊技术使用率、PCI成功率;随访12个月,记录两组患者并发症和主要不良心血管事件(MACE)发生情况。结果 A组患者手术时间短于B组,造影剂用量少于B组(P<0.05);两组患者导丝用量和支架置入数量比较,差异无统计学意义(P>0.05)。A组患者微导管、冠状动脉旋磨使用率及对侧造影、逆向导丝置入者所占比例低于B组(P<0.05)。A组患者PCI成功率高于B组(P<0.05)。两组患者随访期间PCI相关性心肌梗死和窦部夹层发生率比较,差异无统计学意义(P>0.05),而A组患者MACE发生率高于B组(P<0.05)。结论与闭塞12周后行PCI相比,闭塞2~12周行PCI可有效缩短冠状动脉CTO患者手术时间,减少造影剂用量,降低特殊技术使用率,提高PCI成功率,但可能增加MACE发生风险。

Objective To compare the impact on patients with coronary artery chronic total occlusion in different opportunities of PCI. Methods A total of 132 patients with coronary artery chronic total occlusion were selected in the Central Hospital of Tongchuan Mining Bureau from January 2013 to April 2016, and they were divided into A group（n=70） and B group（n=62） according to the opportunity of PCI. Patients in A group received PCI within 2 to 12 weeks after occlusion, while patients in B group received PCI 12 weeks after occlusion. Operation related index, usage rate of special techniques, success rate of PCI, incidence of complications and MACE during 12-month follow-up were compared between the two groups. Results Duration of operation in A group was statistically significantly shorter than that in B group, and dosage of contrast media in A group was statistically significantly less than that in B group（P〈0.05）; no statistically significant differences of guide wire wastage or number of implanted stents was found between the two groups（P〉0.05）. Usage rate of microcatheter and coronary artery spin grinding, proportion of patients received contralateral arteriography and retrograde wire implantation in A group were statistically significantly lower than those in B group（P〈0.05）. Success rate of PCI in A group was statistically significantly higher than that in B group（P〈0.05）. No statistically significant differences of incidence of PCI related myocardial infarction or sinus dissection was found between the two groups during the 12-month follow-up（P〉0.05）, while incidence of MACE in A group was statistically significantly higher than that in B group（P〈0.05）. Conclusion Compared with PCI 12 weeks after occlusion, PCI within 2 to 12 weeks after occlusion can effectively shorten the duration of operation in patients with coronary artery chronic total occlusion, reduce the dosage of contrast media and usage rate of special techniques, improve the success rate of PCI, but may significantly increase the risk of MACE.