冠状动脉慢性闭塞病变介入治疗的效果影响因素及门控核素心肌灌注显像技术的评估价值

Influence Factors of Effects of Interventional Therapy for Coronary Chronic Total Ccclusion and the Evaluation Value of Gated Myocardial Perfusion Imaging

目的探究冠状动脉慢性闭塞病变(CTO)介入治疗效果影响因素及门控核素心肌灌注显像技术(G-MPI)的评估价值分析.方法回顾性分析2014年9月至2017年9月四川大学华西医院收治的经冠状动脉造影证实为CTO的200例住院患者的临床资料,所有患者均行经皮冠状动脉介入治疗(PCI),42例患者于术前2周及术后随访期内行G-MPI检查,比较PCI治疗成功及失败患者的临床资料,采用G-MPI显像评价患者治疗前后心功能指标变化及预后.结果 PCI失败患者近端血管中重度迂曲、闭塞长度≥20 mm、闭塞端缺如、病变重度钙化比例高于PCI成功患者(P<0.05);Logistic回归分析示靶血管中重度钙化、病变近端血管中重度迂曲、闭塞长度≥20mm及闭塞端缺如是手术失败的的独立危险因素;PCI术后患者心功能指标显著改善(P<0.05);G-MPI显示为可逆性缺损的患者心脏事件发生率显著高于显像正常及固定性缺损患者,差异具统计学意义(P<0.05).结论靶血管中重度迂曲、闭塞长度≥20 mm、闭塞端缺如、病变中重度钙化是PCI治疗失败的独立危险因素,临床上可采用G-MPI对PCI患者治疗效果及预后进行评估.

Objective To investigate the influencing factors of effects of interventional therapy for coronary chronic total occlusion（CTO）and the evaluation value of gated myocardial perfusion imaging（G-MPI）.Methods The clinical data of 200 inpatients confirmed as CTO by coronary angiography in the hospital during the period from September 2014 to September 2017 were retrospectively analyzed. All patients were treated by percutaneous coronary intervention（PCI）and 42 patients were examined by G-MPI 2 weeks before the operation and during the postoperative follow-up period. The clinical data were compared between the patients successfully treated by PCI and the patients with PCI failure. G-MPI was used to evaluate the change of heart function before and after the treatment and prognosis.Results The proportions of moderate to severe tortuous proximal vessels, length of occlusion 20 mm,occluded end loss and severe calcification in patients with PCI failure were higher than those in patients successfully treated by PCI（P 〈 0.05）. Logistic regression analysis showed that moderate to severe calcification of target vessels, moderate to severe tortuous proximal vessels, length of occlusion 20 mm and occluded end loss were independent risk factors for operation failure. Cardiac function was significantly improved after PCI（P 〈 0.05）. The incidence of cardiac events in patients with reversible defects shown by G-MPI wassignificantly higher than that in patients with normal images and patients with fixed defects（P 〈 0.05）. Conclusion Moderate to severe tortuous target vessels,length of occlusion 20 mm,occluded end loss and moderate to severe calcification of lesions are independent risk factors for operation failure.Clinically, G-MPI can be used to evaluate the efficacy and prognosis of PCI.