既往有和无冠状动脉旁路移植术的原位血管慢性完全闭塞患者行PCI的效果比较

Comparison of the effect of PCI in patients with prior coronary artery bypass grafting and chronic complete occlusion in situ without CABG

目的比较既往有冠状动脉旁路移植术(CABG)和无CABG的原位血管慢性完全闭塞(CTO)患者行经皮冠状动脉介入术(PCI)的效果。方法回顾性选取2015年1月至2019年12月于河北医科大学第一医院、联勤保障部队第九八〇医院确诊为原位血管CTO病变的患者479例,依据既往有CABG和无CABG情况分为CABG组(n=150)、无CABG组(n=329)两组。比较两组患者的影像学特征、PCI相关指标、生活质量、院内心脏不良事件发生情况。结果无CABG组患者的LM+两支、LM+三支、支架内狭窄、心肌桥比率为10.00%、48.00%、20.00%、18.00%,均明显高于CABG组(1.22%、8.51%、8.51%、9.73%),非LM单支、非LM两支比率为8.00%、6.00%,明显均低于CABG组(37.69%、21.88%),差异均有统计学意义(P<0.05);但两组患者的单纯LM、LM+单支、非LM三支、冠脉夹层的比率之间的差异均无统计学意义(P>0.05)。无CABG组患者的支架个数、支架总长度、造影剂剂量和手术时间为(2.33±0.18)个、(67.45±7.36)mm、(292.32±9.30)mL、(139.25±9.14)min,均明显大于CABG组[(1.71±0.13)个、(54.23±4.62)mm、(202.23±12.54)mL、(69.42±4.36)min],差异均有统计学意义(P<0.05)。无CABG组患者的躯体活动受限程度、心绞痛发作频率、心绞痛稳定状态、疾病认知程度、治疗满意程度评分均明显高于CABG组,差异均有统计学意义(P<0.05)。无CABG组患者的院内心脏不良事件总发生率为14.00%,明显低于CABG组(25.84%),差异有统计学意义(P<0.05)。结论既往无CABG的原位血管CTO患者行PCI的效果较有CABG者好。

Objective To compare the effects of percutaneous coronary intervention(PCI)in patients with prior coronary artery bypass grafting(CABG)and chronic total occlusion(CTO)of vessels in situ without CABG.Methods A total of 479 patients diagnosed with in situ vascular CTO lesions in the First Hospital of Hebei Medical University and the 980 Hospital of Joint Logistic Support Force from January 2015 to December 2019 were retrospectively selected and divided into two groups according to their previous CABG and non-CABG conditions:CABG group(n=150)and non-CABG group(n=329).Imaging characteristics,PCI related indicators,quality of life and incidence of nosocomial adverse cardiac events were compared between the two groups.Results The rates of LM+two,LM+three,stent stenosis and myocardial bridge in patients with non-CABG group were 10.00%,48.00%,20.00%,18.00%,which were significantly higher than those in patients with CABG group(1.22%,8.51%,8.51%,9.73%),the rates of single and non-LM branches were 8.00%,6.00%,which were significantly lower than those of CABG group(37.69%,21.88%),the differences were statistically significant(P<0.05);however,there was no significant difference in the rates of simple LM,LM+single LM,non-LM,and coronary dissection between the two groups(P>0.05).The number of stents,total length of stents,contrast dose and operation time in patients without CABG group were(2.33±0.18)pieces,(67.45±7.36)mm,(292.32±9.30)mL,(139.25±9.14)min,which were significantly higher than those in patients with CABG group[(1.71±0.13)pieces,(54.23±4.62)mm,(202.23±12.54)mL,(69.42±4.36)min],the differences were statistically significant(P<0.05).The degree of physical activity limitation,angina pectoris attack frequency,angina pectoris stable state,disease cognition and treatment satisfaction score of patients without CABG group were significantly higher than those with CABG group,the differences were statistically significant(P<0.05).The total incidence of nosocomial adverse cardiac events in patients without CABG group was 14.00%,which was significantly lower than that in patients with CABG group(25.84%),the difference was statistically significant(P<0.05).Conclusion The effect of PCI in patients with in-situ vascular CTO without PREVIOUS CABG is better than that in patients with CABG.