邢浩然,王锐,张东凤,田晋帆,周渊,张闽,张明多,高秉钰,左惠娟,贺毅,宋现涛

• 1:首都医科大学附属北京安贞医院心内科
• 2:首都医科大学附属北京友谊医院放射科
• 3:北京市心肺血管疾病研究所

摘要(Abstract)：

目的探索影响慢性完全闭塞(CTO)病变行经皮冠状动脉介入治疗(PCI)结局的患者临床特点与冠状动脉造影(CAG)图像特征,对比日本多中心CTO注册中心(J-CTO)评分、临床-病变相关(CL)评分对PCI结局的预测价值。方法纳入2019年1月1日至2019年6月30日于首都医科大学附属北京安贞医院行CAG检查确诊CTO病变并尝试进行PCI的157例患者共162处病变。根据病变行PCI是否全部成功分为PCI成功患者组(121例)以及PCI失败患者组(36例),根据病变最终是否成功开通分为PCI成功组(125处)以及PCI失败组(37处)。收集患者临床及CAG病变特征资料,分析影响CTO-PCI成功的因素,采用CL评分及J-CTO评分分别对病变进行评价,比较预测价值差异。结果 157例患者中男性130例(82.8%),平均年龄(60.0±9.7)岁,最终PCI成功开通CTO病变125处(77.2%)。PCI失败患者组既往CTO病变PCI失败(33.3%比16.5%,P=0.028)、既往PCI(47.2%比28.1%,P=0.035)比例显著大于PCI成功患者组,差异均有统计学意义。PCI失败组近端钝形纤维帽(56.8%比32.0%,P=0.006)、病变长度≥20 mm (67.6%比22.4%,P<0.001)、病变迂曲>45°(45.9%比16.0%,P<0.001)以及侧支循环Rentrop 0～1级比例(27.0%比9.6%,P=0.007),J-CTO评分[(2.24±1.01)分比(1.05±0.94)分,P<0.001]、CL评分[(3.01±1.22)分比(1.80±1.26)分,P<0.001]均高于PCI成功组,差异均有统计学意义。logistic多因素回归分析显示,病变长度≥20 mm(OR 0.216,95%CI 0.082～0.569,P=0.002)、近端钝形纤维帽(OR 0.232,95%CI 0.091～0.590,P=0.002)以及侧支循环Rentrop 0～1级(OR 0.299,95%CI0.094～0.949,P=0.040)为PCI成功开通CTO病变的独立危险因素。CL评分及J-CTO评分预测PCI结局的受试者工作特征曲线下面积分别为0.749(95%CI 0.675～0.814)和0.794(95%CI 0.723～0.853),两者比较差异无统计学意义(P=0.260)。结论病变长度≥20 mm、近端钝形纤维帽以及侧支循环Rentrop 0～1级为PCI成功开通CTO病变的独立危险因素。在预测CTO-PCI结局方面,CL评分与J-CTO评分预测价值相当。

关键词(KeyWords)： 慢性完全闭塞;冠状动脉造影;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（81671650、81971569、81670324）;; 首都卫生发展专项（2018-2-2063）

作者(Author): 邢浩然,王锐,张东凤,田晋帆,周渊,张闽,张明多,高秉钰,左惠娟,贺毅,宋现涛

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