慢性完全闭塞性病变经皮冠脉介入治疗后一年预后分析
One year prognosis of chronic complete occlusive disease after percutaneous coronary intervention
胡思汗 1冯雨嘉 1刘胜囡 1万静1
作者信息
- 1. 武汉大学中南医院心血管内科 湖北 武汉 430071
- 折叠
摘要
目的:探讨经皮冠脉介入治疗术(PCI)开通慢性完全闭塞性病变(CTO)对患者心脏结构和功能的影响,评估手术治疗获益,为临床治疗方案个体化提供指导.方法:回顾性分析2019年1月至2021年6月在武汉大学中南医院行冠状动脉造影发现CTO患者310例.通过门诊复诊记录或电话随访对患者进行观察,记录主要终点事件及次要终点事件发生情况,并根据随访1年时心脏彩超结果了解心脏结构变化.结果:PCI失败组患者1年随访研究显示终点事件发生率明显高于PCI成功组(29.59%vs 15.57%,P<0.05),且PCI失败组患者心血管不良事件发生频率、再次血运重建率明显高于PCI成功组.其中有 108位患者复查心脏彩超结果,配对分析显示PCI开通CTO罪犯血管成功组患者左房内径及左室舒张末期内径较术前缩小、左室射血分数(LVEF)较术前有显著改善(均P<0.05).深入分析效应量结果提示LVEF<50%且PCI成功组患者的LVEF值(Cohen's d 值=0.581)、左房内径(Cohen's d 值=0.854)及左室舒张末期内径(Cohen's d 值=0.433)改善最为明显.多变量Cox回归分析发现,成功的PCI和加用β-受体阻滞剂降低了主要终点的发生率.而SYNTAX Ⅰ得分>32以及术前肌酸激酶同工酶-MB(CK-MB)>25 U/L是主要终点的独立危险因素.结论:PCI开通CTO可减少患者心血管不良事件及再次血运重建的发生率;对于左室射血分数<50%的患者,PCI开通CTO还可改善患者的左室射血分数,提高患者心脏泵功能,缩小左房内径及左室舒张末期内径,逆转心室重构.
Abstract
Objective:To investigate the effects of percutaneous coronary intervention(PCI)to open chronic total occlusive lesions(CTO)on patients'cardiac structure and function,assess surgical treatment's benefits,and guide individualizing clinical treatment plans.Methods:A retrospective analysis of 310 patients with CTO detected by coronary angiography in Zhongnan Hospital of Wuhan University from January 2019 to June 2021 was performed.Patients were observed by outpatient follow-up records or telephone follow-up,primary and secondary endpoint events were recorded,and structural changes in the heart were understood based on cardiac ultrasound results at one year of follow-up.Results:The 1-year follow-up study of patients in the PCI failure group showed a significantly higher rate of end-point events than in the successful PCI group(29.59%vs 15.57%,P<0.05),and the frequency of adverse cardiovascular events and the rate of revascularization were significantly higher in the PCI fail-ure group than in the successful PCI group.In 108 of these patients,cardiac ultrasound results were reviewed.Paired analysis showed that the left atrial internal diameter and left ventricular end-diastolic internal diameter of patients in the successful PCI-opened CTO vascular offender group were signifi-cantly smaller.The left ventricular ejection fraction(LVEF)was significantly improved than before the procedure(all P<0.05).An in-depth analysis of the effect sizes suggested that LVEF(Cohen's d value=0.581),left atrial internal diameter(Cohen's d value=0.854),and left ventricular end-diastolic internal diameter(Cohen's d value=0.433)were most significantly improved in the LVEF<50%with successful PCI-opened CTO vascular offender group.Multivariate Cox regres-sion analysis revealed that successful PCI and the addition of β-blocker reduced the incidence of the pri-mary endpoint.In contrast,SYNTAX Ⅰ score>32,and preprocedural creatine kinase-MB(CK-MB)>25 U/L were independent risk factors for the primary endpoint.Conclusion:Opening chronic total occlusion by PCI reduces the incidence of adverse cardiovascular events and revasculariza-tion;in patients with LVEF<50%,PCI with CTO also improves LVEF and cardiac pump function,reduces LV internal diameter and LV end-diastolic internal diameter,and reverses ventricular remodeling.
关键词
冠状动脉/慢性完全闭塞性病变/经皮冠脉介入治疗/左室功能/预后Key words
Coronary Artery/Chronic Total Occlusion/Percutaneous Intervention/Left Ven-tricular Function/Prognosis引用本文复制引用
基金项目
武汉大学中南医院转化医学与跨学科研究联合基金资助项目(ZNJC202201)
出版年
2024
NETL
NSTL
万方数据