摘要
目的:初步分析合并右冠状动脉(右冠)慢性完全闭塞(CTO)的复杂左主干病变经皮冠状动脉介入治疗(PCI)的疗效.方法:连续纳入 2019 年 1 月至 2022 年 12 月在湖南省人民医院住院的所有复杂左主干病变患者 90 例.根据患者冠状动脉造影血管病变情况分为合并右冠CTO的复杂左主干病变(观察组,n=30)及右冠未发生CTO的复杂左主干病变(对照组,n=60),对患者的临床基线数据、术中情况、造影结果、术后随访结果进行分析.结果:90 例患者中男性 58 例(64.4%).两组间临床基线资料(P均>0.05)、左主干病变情况(P=1.000)、左主干钙化情况(P=0.249)、术前TIMI血流分级(P=1.000)差异均无统计学意义.观察组与对照组比较,术中无复流发生率(3.3%vs.5.0%,P=1.000)、低血压发生率(10.0%vs.8.3%,P=1.000)、心包积液发生率(3.3%vs.0%,P=0.333)、血管内超声(IVUS)使用率(86.7%vs.90.0%,P=0.635)、术中使用循环辅助装置(P=0.699)、术中冠状动脉旋磨率(26.7%vs.21.7%,P=0.597)差异均无统计学意义.中位随访时间为 14.50(11.83,15.85)个月,观察组与对照组比较,复发心绞痛、急性心肌梗死、再次血运重建、心力衰竭再入院、心原性死亡等主要不良心血管事件(MACE)发生率(31.0%vs.32.1%,P=1.000)差异均无统计学意义.结论:对于基础疾病多,无法耐受冠状动脉旁路移植术,合并右冠CTO的复杂左主干病变的患者行PCI可能是一种可行的方法.
Abstract
Objectives:to analyze the efficacy of percutaneous coronary intervention(PCI)for complex left main(LM)lesions combined with chronic total occlusion(CTO)of the right coronary artery.Methods:Ninety patients with complex left main lesions hospitalized in Hunan Provincial People's Hospital from January 2019 to December 2022 were consecutively included.According to the coronary angiographic vascular lesions,patients were divided into complex left main lesions combined with right coronary artery CTO(observation group,n=30)and complex left main lesions without right coronary artery CTO(control group,n=60).The baseline clinical data,intraoperative conditions,angiographic results,and postoperative follow-up results of the patients were analyzed and compared between the two groups.Results:Fifty-eight(64.4%)out of the 90 patients were male.There was no statistically significant difference between the two groups in terms of baseline clinical data(all P>0.05),left main lesion condition(P=1.000),left main calcification condition(P=0.249),and preoperative TIMI flow grading(P=1.000).In the comparison between observation group and the control group,intraoperative occurrence of no-reflow(3.3%vs.5.0%,P=1.000),hypotension(10.0%vs.8.3%,P=1.000),pericardial effusion(3.3%vs.0%,P=0.333),the percentage of intravascular ultrasound(IVUS)use(86.7%vs.90.0%,P=0.635),and the use of circulatory assist device(P=0.699),and the proportion of intraoperative coronary spinning(26.7%vs.21.7%,P=0.597)were all similar between the two groups.The median follow-up time was 14.50(11.83,15.85)months,and the differences in the incidence of major adverse cardiovascular events(MACE)such as recurrent angina,acute myocardial infarction,rebleeding,readmission for heart failure,and cardiac death(31.0%vs.32.1%,P=1.000)were not statistically significant between the observation group and the control group.Conclusions:PCI revascularization may be a viable approach for elderly patients with complex LM lesions with multiple underlying disease,and combined right coronary artery CTO,intolerance and reluctance to CABG.
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