单支冠状动脉慢性完全闭塞性病变血运重建后对心脏功能和预后的影响

The impact of revascularization on cardiac function and prognosis in patients with chronic total occlusion of a single coronary artery

目的探讨单支冠状动脉慢性完全闭塞性(chronic total occlusions,CTO)病变进行血运重建后对心脏功能和预后的影响。方法回顾性收集2020年1月至2022年12月在江门市中心医院心内科住院行冠状动脉造影检查诊断为单支冠状动脉CTO病变(其他冠状动脉血管狭窄程度<70%不需要进行干预)且行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的患者共102例。根据介入处理结果分为成功组(74例)和失败组(28例)。分别收集患者术前、术后3个月以内及术后12个月以后的检测指标,包括血红蛋白(HGB)、肌钙蛋白I(Tn I)、血清肌酐(Scr)、低密度脂蛋白胆固醇(LDL-C)、N末端B型利钠肽原(NT-pro BNP)、左心室舒张末期直径(LVEDD)、左心室射血分数(LVEF)等相关指标,并统计所有患者术中及术后的并发症和主要心血管不良事件(MACE);同时对成功组患者进行亚组分析,观察不同病变血管开通后对心功能的影响。结果成功组患者术后3个月以内和12个月以后的NT-pro BNP[(1731.00±1434.11)pg/ml比(2681.35±2576.17)pg/ml,P=0.002;(772±700.90)pg/ml比(2681.35±2576.17)pg/ml,P<0.001]和LVEF[(49.15±8.64)%比(45.99±9.31)%,P=0.032;(52.84±8.02)%比(45.99±9.31)%,P<0.001]较术前都有改善,术后3个月以内的LVEDD较术前改变没有差异,但术后12个月以后较术前明显减小[(49.81±6.45)mm比(54.72±7.44)mm,P<0.001];失败组术前与术后的NT-pro BNP、LVEDD和LVEF均没有差异。在亚组分析中,前降支(LAD)[BNP:(1727.04±1509.03)pg/ml比(3005.79±2556.64)pg/ml,P=0.016和(633±567.14)pg/ml比(3005.79±2556.64)pg/ml,P<0.001;LVEF:(45.74±6.90)%比(41.08±7.61)%,P=0.032和(50.65±7.27)%比(41.08±7.61)%,P<0.001;LVEDD:(48.75±6.40)mm比(55.87±8.22)mm,P=0.002]和右冠状动脉(RCA)[BNP:(1656.55±1487.10)pg/ml比(2649.89±2892.95)pg/ml,P=0.042和(616.35±528.40)pg/ml比(2649.89±2892.95)pg/ml,P<0.001;LVEF:(53.59±8.15)%比(47.24±9.15)%,P=0.003;LVEDD:(49.71±6.28)mm比(54.27±7.31)mm,P=0.004]开通后对心功能的改善有意义,左回旋支(LCX)开通对心功能改善没有意义。成功组和失败组患者术中、术后并发症和MACE的发生率没有差异,但成功组术后心绞痛发作频率明显减少(χ^(2)=53.175,P<0.001)。结论冠状动脉CTO开通可以改善患者的心功能,并减少了心绞痛的发作,其中LAD和RCA开通意义更大。

Objective To observe the impact of revascularization on cardiac function and prognosis in patients with chronic total occlusion(CTO)of a single coronary artery.Methods This was a retrospective study.A total of 102 patients who were hospitalized in the cardiology department of Jiangmen Central Hospital from January 2020 to December 2022,diagnosed with single-vessel coronary artery CTO lesions(with other coronary artery stenosis less than 70%and not requiring intervention)and underwent percutaneous coronary intervention(PCI)treatment were enrolled.According to the results of the intervention,they were divided into a successful group(74 cases)and a failed group(28 cases).We collected the testing indicators of patients before PCI,within 3 months and after 12 months post-PCI,including hemoglobin(HGB),troponin I(TnI),Serum creatinine(Scr),lowdensity lipoprotein cholesterol(LDL-C),N-terminal brain natriuretic peptide premise(NT-proBNP),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and other related indicators,and all complications and major adverse cardiovascular events(MACE)during and after PCI in all patients were collected.Meantime,a subgroup analysis of the patients in the successful group was conducted to observe the impact of different target vessels revascularizations on cardiac function.Results The NT-proBNP levels in the successful group of patients were significantly different compared to pre-PCI levels at both within 3 months[(1731.00±1434.11)pg/ml vs(2681.35±2576.17)pg/ml,P=0.002 and beyond 12 months(772±700.90)pg/ml vs(2681.35±2576.17)pg/ml,P<0.001].Similarly,the LVEF also showed differences compared to pre-PCI levels[(49.15±8.64)%vs(45.99±9.31)%,P=0.032;(52.84±8.02)%vs(45.99±9.31)%,P<0.001],there was no difference in LVEDD within 3 months after PCI compared to before the procedure,but it significantly decreased beyond 12 months after PCI[(49.81±6.45)mm compared to(54.72±7.44)mm,P<0.001];There were no differences in NTproBNP,LVEDD,and LVEF before and after PCI in the failed group.In the subgroup analysis,the left anterior descending artery(LAD)[BNP:(1727.04±1509.03)pg/ml compared to(3005.79±2556.64)pg/ml,P=0.016 and(633±567.14)pg/ml compared to(3005.79±2556.64)pg/ml,P<0.001;LVEF:(45.74±6.90)%compared to(41.08±7.61)%,P=0.032 and(50.65±7.27)%compared to(41.08±7.61)%,P<0.001;LVEDD:(48.75±6.40)mm compared to(55.87±8.22)mm,P=0.002]and the right coronary artery(RCA)[BNP:(1656.55±1487.10)pg/ml compared to(2649.89±2892.95)pg/ml,P=0.042 and(616.35±528.40)pg/ml compared to(2649.89±2892.95)pg/ml,P<0.001;LVEF:(53.59±8.15)%compared to(47.24±9.15)%,P=0.003;LVEDD:(49.71±6.28)mm compared to(54.27±7.31)mm,P=0.004]showed significant improvement in cardiac function indicators after revascularization,but the opening of the left circumflex artery(LCX)has no significance for improving heart function.There was no difference in the incidence of complications and MACE during and after PCI between two groups,but the frequency of angina attacks was reduced in the successful group(χ^(2)=53.175,P<0.001).Conclusion Coronary CTO recanalization could improve patients'cardiac function and reduce the occurrence of angina,with recanalization of the LAD and RCA being particularly significant.