郭云飞,彭红玉,赵烨婧,柳景华

• 1:首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所

摘要(Abstract)：

目的分析冠状动脉慢性完全闭塞(CTO)病变合并分叉病变介入治疗中分支闭塞的预测因素,探讨分支保护策略,并评估分支闭塞与围术期并发症的关系。方法连续入选2015年1月至2018年7月首都医科大学附属北京安贞医院CTO病变闭塞段近端或远端5 mm范围内存在直径≥2.0 mm分支的患者245例,根据术后分支血流情况分为闭塞组和非闭塞组。结果 36.3%(245/675)CTO病变患者合并分叉病变,其中左前降支分叉病变最常见(63.7%,156/245)。77.1%分叉病变位于闭塞段近端,分支闭塞组真性分叉病变更多见(71.4%比26.8%,P<0.001)。分支闭塞主要发生在主支支架置入后(71.4%)。在logistic多因素分析中,分支无保护(OR 4.61,95%CI 1.25～17.04,P=0.022)、分支开口狭窄≥50%(OR 5.37,95%CI 1.93～14.98,P=0.001)、主支近端狭窄≥50%(OR 2.93,95%CI 1.01～8.49,P=0.047)和采用内膜下夹层再入技术(OR 4.25,95%CI 1.29～13.99,P=0.017)是分支闭塞的独立预测因素。闭塞组伴随更多围术期心肌梗死发生(19.0%比5.4%,P=0.037),单因素logestic分析提示围术期心肌梗死与分支闭塞相关(OR 4.16,95%CI 1.21～14.29,P=0.024)。结论 CTO合并分叉病变介入治疗时,建议常规予以导丝或拘禁球囊保护分支,尤其在分支开口或主支近端明显病变或采用内膜下夹层再入技术时。分支闭塞多发生于主支支架置入后,伴随围术期心肌梗死发生率升高。

关键词(KeyWords)： 慢性完全闭塞病变;经皮冠状动脉介入治疗;分叉病变;并发症

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（81970291）

作者(Author): 郭云飞,彭红玉,赵烨婧,柳景华

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