CT血管造影在经皮冠状动脉介入治疗慢性完全闭塞病变效果评估中价值

Preoperative Evaluation Value of CT Angiography for Chronic Total Occlusion with Percutaneous Coronary Intervention

目的探讨CT血管造影在经皮冠状动脉介入治疗慢性完全闭塞病变(CTO)的评估价值。方法分析我院2014年6月-2016年12月收治210例CTO患者资料,根据术前评估方法的不同分为对照组与观察组。其中106例患者术前接受常规评估方法,纳入对照组;另104例患者术前接受CT血管造影评估,纳入观察组,比较两组患者手术成功情况、左室收缩功能、并发症,分析CTO回归特征。结果观察组患者手术成率显著高于对照组(P<0.05)。术前两组患者左室室壁运动指数、左室射血分数比较差异无统计学意义(P>0.05)。术后,两组患者左室室壁运动指数、左室射血分数均有改变,其中观察组患者左室室壁运动指数较术前下降,且低于对照组(P<0.05),左室射血分数较术前上升,且高于对照组(P<0.05)。观察组患者并发症发生率显著低于对照组(P<0.05)。闭塞段远端纤维帽形态不清晰、闭塞段近端分叉及闭塞段长度≥20mm是影响CTO介入失败的主要因素。结论 CT血管造影在经皮冠状动脉介入治疗慢性完全闭塞病变效果评估有重要作用,能显著提高经皮冠状动脉介入治疗成功率,改善心室功能,减少并发症,值得推荐使用。

Objective To investigate the value of CT angiography in percutaneous coronary intervention for chronic total occlusion(CTO).Methods The data of 210 CTO patients admitted to our hospital from June 2014 to December 2016 were analyzed,and patients were divided into two groups according to the different preoperative evaluation methods,and 106 patients in the control group received routine assessment before operation,while 104 patients in the observation group received the CT angiography before operation.Then the operative success rate,left ventricular systolic function,and complications were compared between the two groups,moreover,the characteristics of CTO regression were analyzed.Results The success rate of patients in the observation group was significantly higher than that in the control group(P<0.05).The preoperative left ventricular wall motion index and left ventricular ejection fraction between the two groups had no difference(P >0.05),which were ameliorated after operation,and the observation group had lower left ventricular wall motion index as well as higher left ventricular ejection fraction than those of the control group(P<0.05).The total incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Multivariate logistic regression analysis showed that the unambiguous distal fibrous cap of the occlusion segment and the occlusion of the proximal branch as well as the occlusion length≥20 mm were the main factors affecting the failure of CTO intervention.Conclusion CT angiography plays an important role in evaluating the effect of percutaneous coronary intervention on chronic total occlusion,which can significantly increase the success rate of percutaneous coronary intervention,and improve the ventricular function,and reduce complications.It is worthy of recommendation.