经皮冠状动脉介入治疗对慢性完全闭塞病变患者预后的影响

Effect of percutaneous coronary intervention on prognosis of patients with chronic coronary total occlusion

目的评价经皮冠状动脉介入(percutaneous coronary intervention PCI)治疗开通慢性完全闭塞病变(CTO)对患者预后的影响。方法前瞻性连续性地选取2016年8月至2017年2月广东省心血管病研究所心内科二区病房共144例冠状动脉CTO住院患者为研究对象,记录患者临床基线特征及CTO开通策略、PCI治疗相关手术并发症和住院期间不良事件,根据手术是否成功分为成功组(n=125)和失败组(n=19)。术后3、6、12个月进行临床随访,随访主要终点事件为主要不良心血管事件(major adverse cardiovascularevent,MACE),包括全因死亡、非致死性心肌梗死(myocardial infarction,MI)或靶血管再次血运重建(targetvessel revascularization,TVR)。比较PCI治疗成功组与失败组患者预后的差别。结果 PCI治疗总成功率为86.8%(125/144)。随访时间为(11.49±2.01)个月,成功组患者总MACE发生率明显低于失败组,差异有统计学意义(5.6%vs. 26.3%,P=0.002);成功组累积无MACE生存率高于失败组(log rank P=0.025)。PCI治疗总的并发症发生率为6.3%(9/144)。与成功组相比,失败组的不良事件发生率较高(P=0.002)。此外,正向与逆向PCI治疗策略对患者累积无MACE生存率无影响(log rank P=0.954)。两种策略术中不良事件发生分别为5例(5.7%)和6例(15.8%),差异无统计学意义(P>0.05)。结论通过正向与逆向PCI治疗策略相结合的方法,开通CTO成功率高,术中并发症发生率较低。成功开通CTO能降低患者1年总MACE发生率,提高累积无MACE生存率。

Objectives To evaluate the clinical outcomes in patients with chronic coronary total occlusion(CTO)afterpercutaneous coronary intervention(PCI). Methods A total of 144 consecutive CTO patients who underwent PCIbetween August 2016 to February 2017 from Department of Cardiology,Guangdong Cardiovascular Institute were en-rolled in this study. The clinical data,coronary angiography characteristics,antegrade or retrograde interventionstrategies,complications of PCI and the procedural outcomes were recorded. These patients were divided into twogroups according to the procedural success(n=125)or failure(n=19). These patients were followed up at 3,6 and 12 months. Major adverse cardiovascular events(MACE),including all-cause mortality,nonfatal myocardial infarction(MI)and target vessel revascularization(TVR)were recorded and compared between the two groups. Results Overallsuccess rate of procedure was 86.8%(125/144). The mean duration of follow-up was(11.49±2.01)months. MACErate was significantly lower in patients with successful PCI of CTO compared to failed PCI of CTO(5.6% vs. 26.3%,log rank P=0.002). Patients with successful PCI of CTO experienced a higher no MACE survival rate(log rank P=0.025). Overall complication rate of procedure was 6.3%(9/144). Adverse procedural events rate was significantlyhigher in patients with failed PCI of CTO compared to successful PCI of CTO(P=0.002). The antegrade and ret-rograde interventions to recanalize CTO had no effect on MACE survival rate(log rank P=0.954). Conclusions CTOPCI is performed through a combination of antegrade and retrograde intervention strategies to achieve high successrate of revascularization and low complication rate. Successful PCI for CTO can reduce MACE rate and improve noMACE survival rate during first year after PCI.