韩鹏,赵帅,禹天同,朱伯达,张博晖,王车,张玺,陈根锐,陈有虎,陈焱,廉坤,李成祥

• 1:中国人民解放军空军军医大学第一附属医院心血管内科
• 2:中国人民解放军联勤保障部队第九八一医院心血管内科
• 3:中国人民解放军西部战区空军医院心血管内科
• 4:西安市红会医院心血管内科

摘要(Abstract)：

目的 评估左心室射血分数（LVEF）≤35%的冠状动脉慢性完全闭塞(CTO)病变患者接受CTO-经皮冠状动脉介入治疗(PCI)成功后的长期临床结局、症状改善及生活质量变化情况。方法 前瞻性连续纳入2018年4月至2021年5月中国人民解放军空军军医大学第一附属医院择期行CTOPCI的患者，按LVEF水平分为两组：LVEF>35%组及LVEF≤35%组。收集并评估所有患者的基线症状、生活质量、住院期间并发症及长期随访数据。研究主要终点为患者症状及生活质量的变化，次要终点为主要不良心血管事件（MACE），包括全因死亡、非致死性心肌梗死及临床驱动的血运重建。结果 本研究共纳入1 076例CTO病变患者，其中LVEF≤35%者114例（10.59%）。与LVEF>35%组962例（89.41%）相比，LVEF≤35%组患者年龄更大，身体质量指数及收缩压更低，高血压患病率较低而既往心肌梗死比例更高，低密度脂蛋白胆固醇、天冬氨酸氨基转移酶及N末端B型脑钠肽前体水平更高；纽约心脏病协会（NYHA）心功能分级Ⅲ/Ⅳ级比例及血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂使用率更高，多支血管病变、多支CTO病变比例更高，且病变血管数亦显著增多，差异均有统计学意义（均P<0.05）。经倾向性评分匹配后，两组院内MACE发生率比较，差异无统计学意义；术后1个月、1年及3年随访时，两组MACE发生率及全因死亡率比较，差异均无统计学意义（均P>0.05）。对CTO-PCI手术成功的患者进行多因素分析，收缩压（OR 1.016, 95%CI 1.000～1.033,P=0.046）和多支病变（OR 6.872,95%CI 1.583～29.844,P=0.010）是3年MACE的独立危险因素；男性（OR 4.336,95%CI 1.688～11.134,P=0.002）和NYHA心功能分级（OR 4.920,95%CI 1.294～18.710,P=0.019）是3年全因死亡的独立危险因素。无论在MACE还是全因死亡率的单因素及多因素分析中，LVEF≤35%均不构成独立预测因子（均P>0.05）。成功CTO-PCI后，LVEF≤35%组在心绞痛症状改善及生活质量提高方面与LVEF>35%组相当，各随访时间点两组间比较，差异均无统计学意义（均P>0.05）。结论 对于低LVEF（≤35%）的CTO病变患者，在成功完成CTO-PCI后心绞痛及呼吸困难症状缓解，生活质量提升，其获益程度与较高LVEF患者相当。成功血运重建使该群体的远期风险趋近于高LVEF患者。

关键词(KeyWords)： 慢性完全闭塞;低左心室射血分数;经皮冠状动脉介入治疗;临床结局;症状;生活质量

Abstract:

Keywords:

基金项目(Foundation): 西京医院医务人员培养助推项目（XJZT24LY39、XJZT25CX44、XJZT26CX49）;; 陕西省重点研发计划一般项目（2025SF-YBXM-310）;; 陕西省自然科学基础研究计划前沿探索项目（2025JC-QYCX-080）

作者(Author): 韩鹏,赵帅,禹天同,朱伯达,张博晖,王车,张玺,陈根锐,陈有虎,陈焱,廉坤,李成祥

参考文献(References)：

• [1]Tajstra M,Pyka L,Gorol J,et al.Impact of chronic total occlusion of the coronary artery on long-term prognosis in patients with ischemic systolic heart failure:insights from the COMMIT-HF registry[J].JACC Cardiovasc Interv,2016,9(17):1790-1797.DOI:10.1016/j.jcin.2016.06.007.
• [2] Zhu J,Niu M,Wang C,et al.Correlation between triglyceride glucose index and collateral circulation formation in patients with chronic total occlusion of coronary arteries in different glucose metabolic states[J].Cardiovasc Diabetol,2024,23(1):26.DOI:10.1186/s12933-023-02080-3.
• [3]Fujimoto Y,Sakakura K,Jinnouchi H,et al.Comparison of outcomes of patients with acute myocardial infarction between chronic total occlusion versus 90-99%stenosis in non-culprit arteries[J].Am J Cardiol,2022,170:17-24.DOI:10.1016/j.amjcard.2022.01.021.
• [4]Casas G,Limeres J,Oristrell G,et al.Clinical risk prediction in patients with left ventricular myocardial noncompaction[J].J Am Coll Cardiol,2021,78(7):643-662.DOI:10.1016/j.jacc.2021.06.016.
• [5]Tian J,Liu L,Yang X,et al.Cardiac magnetic resonance follow-up of myocardial function in patients with chronic total occlusion of the coronary arteries:a retrospective cohort study[J].Cardiovasc Diagn Ther,2025,15(3):610-623.DOI:10.21037/cdt-24-492.
• [6]Sammour YM,Bou Chaaya RG,Kharsa C,et al.Assessment of left ventricular function after percutaneous coronary intervention for chronic total occlusion[J].J Soc Cardiovasc Angiogr Interv,2025,4(1):102460.DOI:10.1016/j.j scai.2024.102460
• [7] Guo L,Meng S,Lv H,et al.Long-term outcomes of successful recanalization compared with optimal medical therapy for coronary chronic total occlusions in patients with and without left ventricular systolic dysfunction[J].Front Cardiovasc Med,2021,8:654730.DOI:10.3389/fcvm.2021.654730.
• [8]Simsek B,Kostantinis S,Karacsonyi J,et al.Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ej ection fraction[J].Catheter Cardiovasc Interv,2022,99(4):105 9-1064.DOI:10.1002/ccd.30097.
• [9]El Awady WS,Samy M,Al-Daydamony MM,et al.Periprocedural and clinical outcomes of percutaneous coronary intervention of chronic total occlusions in patients with low-and mid-range ej ection fractions[J].Egypt Heart J,2020,72(1):28.DOI:10.1186/s43044-020-00065-1.
• [10] Galassi AR,Boukhris M,Toma A,et al.Percutaneous coronary intervention of chronic total occlusions in patients with low left ventricular ejection fraction[J].JACC Cardiovasc Interv,20 17,10(21):2158-2170.DOI:10.1016/j.jcin.2017.06.058.
• [11]Toma A,St??hli BE,Gick M,et al.Comparison of benefit of successful percutaneous coronary intervention for CTO in patients with versus without reduced(≤40%)LVEF[J].Am J Cardiol,2017,120(10):1780-1786.DOI:10.1016/j.amjcard.2017.07.088.
• [12]Wen S,Dai C,Huang Z,et al.Retrograde percutaneous coronary intervention for chronic total occlusions in patients with reduced left ventricular ejection fraction:a single-center retrospective cohort study[J].Heart Vessels,2025,40(9):814-825.DOI:10.1007/s003 80-025-02526-6.
• [13]Werner GS,Martin-Yuste V,Hildick-Smith D,et al.A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chro nic total co ronary occlusions[J].Eur Heart J,2018,39(26):2484-2493.DOI:10.1093/eurheartj/ehy220.
• [14]Lee SW,Lee PH,Ahn JM,et al.Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion[J].Circulation,2019,139(14):1674-1683.DOI:10.1161/CIRCULATIONAHA.118.031313.
• [15]Morino Y,Abe M,Morimoto T,et al.Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes:the J-CTO(Multicenter CTO Registry in Japan)score as a difficulty grading and time assessment tool[J].JACC Cardiovasc Interv,2011,4(2):213-221.DOI:10.1016/j.jcin.2010.09.024.
• [16]Spertus JA,Winder JA,Dewhurst TA,et al.Development and evaluation of the Seattle Angina questionnaire:a new functional status measure for coronary artery disease[J].J Am Coll Cardiol,1995,25(2):333-341.DOI:10.10 16/0735-1097(94)00397-9.
• [17]Rabin R,de Charro F.EQ-5D:a measure of health status from the EuroQol Group[J].Ann Med,2001,33(5):3 3 7-3 4 3.DOI:10.3109/07853890109002087.
• [18]Tsuchiya A,Ikeda S,Ikegami N,et al.Estimating an EQ-5D population value set:the case of Japan[J].Health Econ,2002,11(4):341-353.DOI:10.1002/hec.673.
• [19]朱伯达,赵帅,汪钦,等.经皮冠状动脉介入治疗冠状动脉慢性完全闭塞合并左心室射血分数降低患者的远期疗效[J].中国介入心脏病学杂志,2022,30(3):193-198.DOI:10.3969/j.issn.1004-8812.2022.03.006.
• [20]Brilakis ES,Mashayekhi K,Tsuchikane E,et al.Guiding principles for chronic total occlusion percutaneous coronary inte rvention[J].Circulation,2019,140(5):420-433.DOI:10.1161/CIRCULATIONAHA.119.0 3 9797.
• [21] Harding SA,Wu EB,Lo S,et al.A new algorithm for crossing chronictotal occlusions from the asia pacific chronic total occlusion club[J].JACC Cardiovasc Interv,2017,10(21):2135-2143.DOI:10.1016/j.jcin.2017.06.071.
• [22]Wyman RM.Antegrade dissection and reentry:tools and techniques[J].Interv Cardiol Clin,2021,10(1):41-50.DOI:10.1016/j.iccl.2020.10.001.
• [23]Assali M,Buda KG,Megaly M,et al.Update on chronic total occlusion percutaneous coronary intervention[J].Prog Cardiovasc Dis,2021,69:27-34.DOI:10.1016/j.pcad.2021.11.004.
• [24]Guan C,Yang W,Song L,et al.Association of acute procedural results with long-term outcomes after CTO PCI[J].JACC Cardiovasc Interv,2021,14(3):278-288.DOI:10.1016/j.jcin.2020.10.003.
• [25]Mashayekhi K,Nührenberg TG,Toma A,et al.A randomized trial to assess regional left ventricular function after stent implantation in chronic total occlusion:the REVASC trial[J].JACC Cardiovasc Interv,2018,11(19):1982-1991.DOI:10.1016/j.jcin.2018.05.041.
• [26]Godino C,Giannattasio A,Scotti A,et al.Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlu sion[J].Heart,2019,105(14):1096-1102.DOI:10.1136/heartjnl-2018-314076.
• [27] Salisbury AC,Sapontis J,Grantham JA,et al.Outcomes of chronic total occlusion percutaneous coronary intervention in patients with diabetes:insights from the OPEN CTO registry[J].JACC Cardiovasc Interv,2017,10(21):2174-2181.DOI:10.1016/j.jcin.2017.08.043.
• [28]Walsh SJ,Hanratty CG,Mcentegart M,et al.Intravascular healing is not affected by approaches in contemporary CTO PCI:the CONSISTENT CTO study[J].JACC Cardiovasc Interv,2020,13(12):1448-1457.DOI:10.1016/j.jcin.2020.03.032.
• [29]Sapontis J,Salisbury AC,Yeh RW,et al.Early procedural and health status outcomes after chronic total occlusion angioplasty:a report from the OPEN-CTO Registry(Outcomes,Patient Health Status,and Efficiency in Chronic Total Occlusion Hybrid Procedures)[J].JACC Cardiovasc Interv,2017,10(15):1523-1534.DOI:10.1016/j.jcin.2017.05.065.
• [30] Khariton Y,Airhart S,Salisbury AC,et al.Health status benefits of successful chronic total occlusion revascularization across the spectrum of left ventricular function:insights from the OPENCTO registry[J].JACC Cardiovasc Interv,2018,11(22):2276-2283.DOI:10.1016/j.j cin.2018.07.05 8.
• [31]Khan S,Sajjad U,Fawaz S,et al.Randomized,placebo-controlled trial of chronic total occlusion percutaneous coronary intervention in stable angina:the ORBITA-CTO trial[J].J Am Coll Cardiol,2026,88(1):4-18.DOI:10.1016/j.j acc.2026.03.027.
• [32]张宇超,吴铮,王韶屏,等.优化左心室收缩功能不全合并冠状动脉慢性完全闭塞患者介入治疗结局的研究进展[J].中国介入心脏病学杂志,2024,32(7):396-404.DOI:10.3969/j.issn.1004-8812.2024.07.005.
• [33]张宇超,吴铮,高海,等.冠状动脉慢性完全闭塞病变合并左心室收缩功能不全:治疗策略及生存模型[J].中国介入心脏病学杂志,2025,33(12):696-708.DOI:10.3969/j.issn.1004-8812.2025.12.004.
• [34] Safley DM,Grantham JA,Hatch J,et al.Quality of life benefits of percutaneous coronary intervention for chronic occlusions[J].Catheter Cardiovasc Interv,2014,84(4):629-634.DOI:10.1002/ccd.25 303.
• [35]Rossello X,Pujadas S,Serra A,et al.Assessment of inducible myocardial ischemia,quality of life,and functional status after succes sful percutaneous revascularization in patients with chronic total coronary occlusion[J].Am J Cardiol,2016,117(5):720-726.DOI:10.1016/j.amjcard.2015.12.001.
• [36]Dunlay SM,Roger VL,Redfield MM.Epidemiology of heart failure with preserved ejection fraction[J].Nat Rev Cardiol,2017,14(10):5 91-602.DOI:10.103 8/nrcardio.2017.65.