冠状动脉钙化程度对冠状动脉完全闭塞性病变介入治疗的影响

Influence of coronary artery calcification severity on percutaneous coronary intervention for chronic total occlusion of coronary artery

目的研究不同严重程度冠状动脉(冠脉)钙化的存在对于冠脉慢性完全闭塞性病变(CTO)患者经皮冠脉介入治疗(PCI)的影响。方法采用回顾性分析,纳入2019年11月至2021年11月间于辽宁省人民医院心内科成功接受PCI的冠脉慢性完全闭塞性病变患者205例,且术中造影结果均证实CTO病变部位存在钙化,根据病变的钙化程度,按照无钙化/轻度钙化(n=119)和中度/重度钙化(n=86)分为两组,分析比较两组患者的基线资料、病变特征、手术策略及手术结局。结果中度/重度钙化的CTO患者的年龄、1年以上吸烟史、糖尿病史、高血压史及既往搭桥手术史显著高于无钙化/轻度钙化的CTO患者,差异有统计学意义(P<0.05)。从病变特征上来看,中度/严重钙化组的J-CTO评分更高(3.3±1.0分vs.1.9±0.50分,P<0.001),钝性出口更多(70.9%vs.21.0%,P<0.001),管腔直径更大(3.0 mm vs.2.4 mm,P<0.001),病变更长(30 mm vs.26 mm,P<0.001)等特点。此外,中度/重度钙化组的患者,手术时间更长(165 min vs.108 min,P<0.001),透视时间更久(85 min vs.45min,P<0.001),造影剂应用更多(260.1 ml vs.180.0 ml,P<0.001)。但两组在技术成功率(89.5%vs.95.8%,P=0.141)和手术成功率(86.0%vs.93.3%,P=0.085)相比,差异均无统计学意义。结论相较于无钙化/轻度钙化的CTO病变,中度/重度钙化的CTO病变手术更加复杂,所需手术时间和透视时间更长,造影剂用量更多,但对于经验丰富的术者,钙化病变的程度对于CTO-PCI的手术成功率及术后安全性事件的发生情况并无影响。

Objective To study the influence of the severity of coronary artery calcification(CAC)in varying degrees on percutaneous coronary intervention(PCI)in patients with chronic total occlusion of coronary artery(CTO).Methods CTO patients(n=205)undergone successful PCI were chosen by using retrospective method from Department of Cardiology in People’s Hospital of Liaoning Province from Nov.2019 to Nov.2021,and their angiography results confirmed CAC in CTO position during PCI.All patients were divided,according to CAC severity,into non-CAC/mild CAC group(n=119)and moderate CAC/severe CAC group(n=86).The baseline data,lesion features,surgical strategy and operation outcomes were analyzed and compared in 2 groups.Results The age and cases with histories of smoking over 1 y,diabetes,hypertension and previous bypass surgery were all higher in moderate CAC/severe CAC group than those in non-CAC/mild CAC group(P<0.05).In terms of lesion features,J-CTO scores were higher(3.3±1.0 vs.1.9±0.50,P<0.001),blunt outlets were more(70.9%vs.21.0%,P<0.001),lumen diameter was larger(3.0 mm vs.2.4 mm,P<0.001),and lesion period was longer(30 mm vs.26 mm,P<0.001)in moderate CAC/severe CAC group.In addition,the operation time was longer(165 min vs.108 min,P<0.001),fluoroscopy time was longer(85 min vs.45 min,P<0.001),and contrast agent dosage was more(260.1 ml vs.180.0 ml,P<0.001)in moderate CAC/severe CAC group.The differences in technical success rate(89.5%vs.95.8%,P=0.141)and operation success rate(86.0%vs.93.3%,P=0.085)had no statistical significance between 2 groups.Conclusion Compared CTO with non-CAC/mild CAC,the surgery for CTO with moderate CAC/severe CAC is more complex,operation time and fluoroscopy time are longer,and contrast agent dosage is more.But for experienced operators,the severity of CAC has no influence on the success rate of CTO-PCI and occurrence of postoperative security events.