冠状动脉慢性完全闭塞病变介入治疗后非闭塞病变进展的危险因素研究

The risk factors of non-occlusive lesions progression in patients undergoing percutaneous coronary intervention

目的探讨冠状动脉慢性完全闭塞病变(CTO)患者在经皮冠状动脉介入(PCI)治疗后非闭塞病变进展的危险因素。方法回顾性分析2017年9月至2018年9月于首都医科大学附属北京安贞医院行PCI治疗后12个月内进行第2次冠状动脉造影的90例患者。依据非闭塞病变进展情况分为未进展组(61例)和进展组(29例)。比较2组临床资料并分析与非闭塞病变进展相关的危险因素。结果进展组替格瑞洛使用率高于未进展组,氯吡格雷和血管紧张素转换酶抑制剂使用率均低于未进展组,差异均有统计学意义(均P <0.05)。进展组C反应蛋白、二磷酸腺苷(ADP)途径血小板聚集率高于未进展组[2.76(1.19,5.92) mg/L比0.95(0.45,3.11) mg/L、(52±15)%比(40±17)%],差异均有统计学意义(均P <0.05)。进展组置入支架总长度短于未进展组,差异有统计学意义(P <0.05)。偏相关分析结果显示,ADP途径血小板聚集率水平与非闭塞病变进展呈正相关(r=0.351,P <0.001)。以ADP途径血小板聚集率水平30%为界值预测非闭塞病变进展为最佳,其敏感度和特异度分别为86.2%和68.9%。结论 ADP途径血小板聚集率可能是CTO介入治疗后非闭塞病变进展的预测因素。血小板功能监测和充分的抗血小板治疗对接受复杂PCI的患者是十分必要的。

Objective To investigate the risk factors of progression of non-occlusive lesions( NOL) after percutaneous coronary intervention( PCI) in patients with coronary artery chronic total occlusion( CTO).Methods Totally 90 patients who underwent second coronary angiography within 12 months after PCI from September 2017 to September 2018 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed. The patients were divided into progression group( 29 cases) and progression-free group( 61 cases),according to the progression of non-occlusive lesions. The clinical data of the two groups were compared and the risk factors associated with the progression of non-occlusive lesions were analyzed. Results The uses of ticagrelor in the progression group was higher than that in the progression-free group;the use of clopidogrel and angiotensin converting enzyme inhibitor were lower than those in the progression-free group( all P < 0. 05). The C-reactive protein and platelet aggregation rate of adenosine diphosphate( ADP) in the progression group were higher than those in the progression-free group[2. 76( 1. 19,5. 92) mg/L vs 0. 95( 0. 45,3. 11) mg/L,( 52 ± 15) % vs( 40 ±17) % ]( both P < 0. 05). The total length of the implanted stent in the progression group was shorter than that in the progression-free group( P < 0. 05). Partial correlation analysis results showed that the level of ADP was positively correlated with the progression of non occlusive disease( r = 0. 351,P < 0. 001). The progression of non-occlusive lesions could be predicted by ADP level of 30%. The sensitivity and specificity were 86. 2% and68. 9%,respectively. Conclusions Platelet aggregation rate of ADP may be a predictor of non-occlusive lesions progression after PCI for the CTO lesion. Platelet function monitoring and adequate antiplatelet therapy are essential for patients undergoing complex PCI.