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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2019年03期

页码:

154-158

栏目:

临床研究

出版日期:

2019-05-27

文章信息/Info

Title:

Outcomes of percutaneous coronary intervention for chronic total occlusion in patients with previous coronary artery bypass grafting

作者:

王世勋 高力明 郭蔚 游洁芸 李纪明 耿亮 王兴旭 姜文斌 徐景涛 邵静波 张奇

261041 山东,潍坊市人民医院心内二科(王世勋,徐景涛,邵静波),潍坊市人民医院心外科(姜文斌); 200120上海市东方医院心脏内科(高力明,郭蔚,游洁芸,李纪明,耿亮,王兴旭,张奇)

Author(s):

WANG Shixun¹;  GAO Liming²;  GUO Wei²;  YOU Jieyun²;  LI Jiming²;  GENG Liang²;  WANG Xingxu²;  JIANG Wenbin³;  XU Jingtao¹;  SHAO Jingbo¹;  ZHANG Qi²

1.Department of Cardiology, Weifang People's Hospital, Shandong 261041; 2.Department of Cardiology, Shanghai East Hospital, Shanghai 200120; 3.Department of Cardiac Surgery, Weifang People's Hospital, Shandong 261041, China

关键词:

冠状动脉介入术;  冠状动脉旁路移植术;  慢性完全闭塞;  预后

Keywords:

Percutaneous coronary intervention;  Coronary artery bypass grafting;  Chronic total occlusion;  Prognosis

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2019.03.007

文献标识码:

-

摘要:

目的:评估经皮冠状动脉(冠脉)介入术(PCI)治疗冠脉旁路移植术(CABG)后患者慢性完全闭塞(CTO)病变的安全性和临床预后。方法:回顾性分析2016年6月至2017年10月57例CABG后发生CTO病变而接受PCI的患者。比较PCI成功组(n=50)和失败组(n=7)患者的临床、冠脉造影、介入治疗情况及临床随访1年时主要不良心血管事件(MACE)的发生情况。结果:PCI失败组患者年龄较大,高血压、糖尿病、高血脂、既往PCI史等发生率高于PCI成功组,与PCI成功组相比,PCI失败组左室射血分数(LVEF)显著降低[(45.9±8.6)%对(59.2±7.3)%,P<0.001)],CABG术后平均时间较长[(98.9±31.3)个月对(67.2±36.2)个月,P=0.03)],桥血管闭塞3根以上的比例也较高(48.9%对6.0%,P=0.02),院内MACE发生率较高(28.6%对2.0%,P=0.04)。临床随访1年发现,两组MACE生存率无差异,但PCI失败组死亡率较高。多因素回归分析表明,PCI失败、桥血管闭塞数量、急性冠脉综合征、年龄>75岁,LVEF<0.40是术后1年死亡的独立预测因子。结论:PCI治疗CABG后CTO病变的总体成功率高,但PCI失败患者预后较差。

Abstract:

Objective:To evaluate the safety and efficacy of percutaneous coronary intervention(PCI)for chronic total occlusion(CTO)in patients who had undergone coronary artery bypass grafting(CABG).Methods:Data from 57 post-CABG patients undergoing PCI for CTO from June 2016 to October 2017 were retrospectively analyzed. Clinical features, coronary angiography, interventional therapy and the incidence of major adverse cardiovascular events(MACE)within one-year follow-up were compared between the success group(n=50)and the failed group(n=7).Results:The patients in failed PCI group were older and had a higher prevalence of hypertension, diabetes, hyperlipidemia, and prior PCI surgery than those in success group. Compared with success group, in failed group the left ventricular ejection fraction(LVEF)was significantly lower [(45.9±8.6)% vs(59.2±7.3)%, P<0.001], with a longer mean time after CABG procedure [(98.9±31.3)months vs(67.2±36.2)months, P=0.03], and the proportion of patients with at least 3 occluded grafts was also significantly increased(48.9% vs. 6.0%, P=0.02). The incidence of MACE during hospitalization(28.6% vs. 2.0%, P=0.04)and one-year mortality were significantly higher in failed group, though there was no significant differences in the incidence of MACE at one year. Multivariate regression analysis indicated that PCI treatment failure, number of occluded grafts, acute coronary syndrome, age>75 years, and LVEF<0.40 were independent predictors for one-year death.Conclusions:The overall success rate of PCI for CTO in post-CABG patients is high, however those with failed PCI treatment could have a poor prognosis.

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备注/Memo

备注/Memo:

基金项目:“浦东新区卫生系统重点学科群”建设资助(PWZxq2017-06)
通信作者:张奇,Email:zhangqnh@hotmail.com

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更新日期/Last Update: 2019-05-27