冠状动脉慢性闭塞病变介入治疗成功的因素及其对预后的影响

Determinants of successful recanalization of chronic coronary arterial total occlusion by percutaneous intervention and the prognosis

目的 探讨影响冠状动脉 (冠脉 )慢性闭塞病变介入治疗成功的因素及其对预后的影响。方法 在 2 0 0 0年 6月至 2 0 0 3年 4月间对 5 2例冠脉慢性闭塞病变患者行经皮冠脉介入治疗 (PCI) ,其中 30例闭塞冠脉成功开通 (开通组 ) ,2 2例闭塞冠脉无法开通 (未开通组 )。比较两组的临床特点和预后。结果 与未开通组比 ,开通组高血压的发生率 (5 3%对 2 3% )较高 (P <0 .0 5 )。推测的血管堵塞时间较短 (P <0 .0 1) ,总胆固醇含量较低 ,分别为 (4 .8± 0 .85 )和 (5 .6± 1.5 )mmol/L(P <0 .0 5 ) ,闭塞病变呈平齐截断或有桥侧支或在分支开口附近或病变长度较长者比例较低 (17%对 4 5 % ,P <0 .0 5 ) ;随访期无胸痛胸闷者比例较高 (73%对 5 0 % ,P <0 .0 5 ) ;再次PCI ,外科冠脉旁路手术和再次住院的联合终点少 (13%对 36 % ,P <0 .0 5 )。结论 冠脉慢性闭塞病变的PCI成功率与推测的堵塞时间和闭塞病变的形态有关。

Objective To evaluate the determinants of successful recanalization of chronic coronary arterial total occlusion(CTO) by percutaneous coronary intervention(PCI) as well as the effect of the recanalization on the prognosis of the patients. Methods Fifty-two patients with CTO were treated by PCI. 30 patients (duration more than one month) were successfully recanalized with stent implantation. Their clinical features and prognosis were compared with those without successful recanalization. Results Compared with patients without successful recanalization, patients with successful recanalization had a higher incidence of hypertension(53% vs 23%, P <0.05), shorter duration of the predicted occlusion( P <0.01), lower plasma concentration of total cholesterol[(4.8±0.85) vs (5.6±1.5) mmol/L, P <0.05], lower percentage of the lesions with clear out stump or with bridging collaterals or with a branch at orifice or of long segment (17% vs 45%, P <0.05); more frequently free of angina(73% vs 50%, P <0.05) and had lower combination end points including repeated PCI, CABG and hospilization(13% vs 36% P <0.05) during follow-up. Conclusions Duration of occlusion, the length of occlusion, the occlusion with a missing stump or bridging collaterals are key factors for success or failure of recanalization of TCO by PCI. Patients with successful PCI of CTO have a better prognosis.