朱伯达,赵帅,汪钦,王伟,郭梦珂,杨茂森,沙治霖,申安心,徐绥宁,陈根锐,谭志军,文亮,杨丽,高好考,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内科
• 2:中国人民解放军空军军医大学基础医学院学员队
• 3:中国人民解放军空军军医大学药学系生物制药学教研室
• 4:中国人民解放军空军军医大学卫生统计学教研室

摘要(Abstract)：

目的 评价冠状动脉慢性完全闭塞（CTO）病变合并左心室射血分数（LVEF）降低的患者经皮冠状动脉介入治疗（PCI）术后的远期疗效。方法 连续纳入2012年1月至2018年2月在中国人民解放军空军军医大学第一附属医院接受择期PCI的CTO病变患者，根据LVEF将其分为A组（LVEF≥50%）、B组（50%>LVEF≥40%）、C组（LVEF<40%）。收集详细的基线资料、术中数据和长期随访资料，分析CTO病变合并LVEF降低的患者行PCI的远期疗效和风险预测因子。结果共1197例CTO-PCI患者，平均年龄（61.92±10.71）岁，男性占84.21%。根据基线LVEF，将研究人群分为3组：A组682例（56.98%）,B组268例（22.39%）,C组247例（20.63%）。C组患者卒中（9.72%比4.11%,P=0.010）、高尿酸血症（26.72%比9.09%,P=0.002）、慢性肾病（5.26%比1.47%,P=0.012）、既往心肌梗死（29.55%比11.88%,P<0.001）均显著高于A组患者，差异均有统计学意义。C组34.01%患者有严重的呼吸困难（纽约心脏病协会心功能分级Ⅲ～Ⅳ级）。C组比A组与B组支架数量和手术时间均有轻微增加[（2.10±2.17）枚比（1.83±1.85）枚比（1.78±1.84）枚，P=0.398;(104.60±49.31)min比（96.96±51.27）min比（101.67±54.73）min,P=0.178]，差异均无统计学意义，但其手术成功率明显低于A组与B组（84.21%比93.84%比94.03%,P<0.001）。成功随访1029例（85.96%）CTO病变患者，平均随访时间为（44.82±22.89）个月。C组主要不良心血管事件发生率和全因死亡率明显高于A组与B组（30.88%比16.48%比22.61%;28.57%比11.09%比16.58%，均P<0.001）。多因素Cox分析发现，糖尿病（HR 1.923,95%CI 1.273～2.904,P=0.002）和LVEF<40%(HR 3.178,95%CI 1.950～5.181,P<0.001)是患者全因死亡的独立危险因素。结论 PCI是CTO病变合并LVEF降低患者一种有效的血运重建治疗策略，可以显著改善其心功能，获得良好的远期疗效。

关键词(KeyWords)： 慢性完全闭塞;心力衰竭;预后;风险预测因子

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱伯达,赵帅,汪钦,王伟,郭梦珂,杨茂森,沙治霖,申安心,徐绥宁,陈根锐,谭志军,文亮,杨丽,高好考,廉坤,李成祥

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