冠状动脉慢性完全闭塞合并分叉病变介入策略及围手术期并发症分析

Interventional strategies and perioperative complications of chronic total coronary occlusion in combination with bifurcation lesions

目的分析冠状动脉慢性完全闭塞(CTO)合并分叉病变临床特征、介入策略及围手术期并发症发生情况。方法采用横断面研究方法,纳入2015年1月至2018年7月于首都医科大学附属北京安贞医院行慢性完全闭塞病变经皮冠状动脉介入治疗(CTO-PCI)患者673例。根据CTO闭塞段前后5 mm范围内是否有分支(直径≥2 mm)发出,将患者分为分叉组(337例)和非分叉组(336例),年龄、血管直径等不符合正态分布,采用M(Q_(1),Q_(3))表示。比较两组患者临床基线特征、冠状动脉造影特点、介入治疗策略及围手术期并发症发生情况。结果分叉组患者年龄为60(51,65)岁,男性占86.6%(292例);非分叉组患者年龄60(52,66)岁,男性占83.0%(279例)。CTO患者冠状动脉病变以多支病变为主,其中三支病变占59.9%(403例),双支病变占25.4%(171例)。分叉组靶血管病变以前降支为主(62.3%,210例),非分叉组靶血管以右冠状动脉更多见(56%,188例)。分叉组靶血管直径为2.91(2.71,3.24)mm,大于非分叉组的2.80(2.55,3.13)mm(P<0.001)。88%(592例)的患者采用正向技术开通闭塞冠状动脉,而分叉组正向开通技术使用比例(91.9%,307例)比非分叉组(84.8%,285例)更高(P=0.012)。72.8%(490例)的患者取得CTO-PCI造影成功。共有10.8%(73例)患者出现了围手术期并发症,分叉组围手术期心肌梗死发生率5.9%(20例)高于非分叉组2.7%(9例)(P=0.038)。结论CTO合并分叉病变临床较常见,靶血管多见于前降支,且靶血管直径更大,介入开通更多采用正向策略,伴随更多围手术期心肌梗死。

Objective To analyze the clinical characteristics of chronic total coronary occlusion(CTO)combined with bifurcation lesions and the features of coronary intervention and perioperative complications.Methods This study adopted retrospective cross-sectional research methods and included 673 patients who underwent interventional therapy for chronic total occlusion in Beijing Anzhen Hospital.According to whether there were side branches(diameter≥2 mm)within 5 mm before and after the CTO occlusion segment,patients were divided into bifurcation group(337 cases)and non-bifurcation group(336 cases).The measurement data did not conform to the normal distribution and were represented as M(Q_(1),Q_(3)).The clinical risk factors,coronary angiography characteristics,interventional treatment strategies and perioperative complications were compared between the two groups.Results The patients in the bifurcation group were 60(51,65)years old,and 86.6%(292 cases)were male;the patients in the non-bifurcation group were 60(52,66)years old,and 83.0%(279 cases)were male.Coronary artery disease in all patients was mainly multivessel disease,of which three-vessel disease accounted for 59.9%(403 cases)and double-vessel disease accounted for 25.4%(171 cases).The target vessel in the bifurcation group was predominantly left anterior descending artery(62.3%,210 cases),and the target vessel in the non-bifurcation group was more common in the right coronary artery(56%,188 cases).The target vessel diameter was larger in the bifurcation group(2.91(2.71,3.24)mm vs 2.80(2.55,3.13)mm,P<0.001).Most patients used the antegrade technique(88%,592 cases),and the use of antegrade technique in the bifurcation group(91.9%,307 cases)was higher than that in the non-bifurcation group(84.8%,285 cases)(P=0.012).After CTO-PCI,72.8%(490 cases)of patients achieved successful angiography.A total of 73 patients(10.8%)had perioperative complications,and there was no statistical difference between the two groups.However,the incidence of perioperative myocardial infarction was higher in the bifurcation group(5.9%,20 cases)than non-bifurcation group(2.7%,9 cases)(P=0.038).Conclusions CTO complicated with bifurcation lesions are very common in clinical practice.Most patients with CTO have multiple coronary artery disease at the same time.The target vessel is more common in the left anterior descending artery,and the diameter of the vessel is larger.It is more common to use antergrade technique,accompanied by more perioperative myocardial infarctions.