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目的探讨慢性完全闭塞性病变(CTO)病变术前远端血管血流状态对PCI术后临床症状及心功能的影响。方法病例入选条件:完全性血管闭塞;闭塞时间≥1个月;PCI达到造影成功标准;应用药物洗脱支架。符合上述条件的患者89例,男性59例,女性30例,年龄40- 79岁。病变血管分布:左主干病变2例、LAD病变39例、LCX病变16例、RCA病变24例、LAD+RCA病变5例、LAD+LCX病变3例。将上述患者分成: A组24例,CTO远端血管床前向或逆向血流正常或接近正常。B组42例,CTO远端血管床前向或逆向血流减少。C组23例,CTO远端血管床前向或逆向血流显著减少或几乎无血流。三组年龄、性别及病变血管分布差异无统计学意义。PCI后随访半年,分别应用CCS标准进行心绞痛分级(CCSS)、NYHA标准进行心功能分级(NYHAS)、二维超声心动图评价左室射血分数(EF),并评估累计主要不良心血管事件[(MACE),包括非致死心肌梗死、靶血管再次PCI或CABG、心血管死亡]的发生率。结果三组PCI术前后比较:CCSS分别为3．0±0．4和1．5±0．2(P<0．01)、3．5±0．6和1．9±0．5(P<0．01)、1．8±0．6和1．6±0．4(P>0．05)。NYHAS分别为2．6±0．3和1．5±0．4(P<0．01)、3．0±0．9和2．0±0．3(P<0．01)、2．8±0．5和2．6±0．6(P>0．05)。EF分别为45．5％±9．9％和50．9％±10．5％(P<0．01)、44．8％±9．6％和46．3％±8．5％(P<0．01)、39．1％±10．2％和40．2％±11．1％(P>0．05)。MACE分别为4．2％、7．1％和13．0％(P>0．05)。结论CTO病变PCI术对缓解心绞痛及改善心功能的疗效取决于PCI前远端血管床的血流状态及存活心肌的数量。
Objective To investigate the effect of preoperative distal blood flow on the clinical symptoms and cardiac function after PCI in patients with chronic total occlusive disease (CTO). Methods Case selection conditions: complete vascular occlusion; occlusion time ≥ 1 month; PCI to achieve the success of imaging standards; the use of drug-eluting stent. In line with the above conditions, 89 patients, 59 males and 30 females, aged 40-79 years. Lesions Vascular distribution: Left main trunk lesion in 2 cases, LAD lesion in 39 cases, LCX lesion in 16 cases, RCA lesion in 24 cases, LAD + RCA lesion in 5 cases, LAD + LCX lesion in 3 cases. The above patients were divided into: A group of 24 patients, CTO distal vascular bed forward or reverse blood flow normal or near normal. B group 42 cases, CTO distal vascular bed anterior or reverse blood flow decreased. Among 23 cases in group C, the anterior or posterior flow of CTO distal vascular bed significantly reduced or almost no blood flow. Three groups of age, gender and vascular lesions no significant difference. PCI was followed up for six months. CCSS, NYHAAS, and left ventricular ejection fraction (EF) were evaluated by CCS standard and cumulative adverse cardiovascular events [ (MACE), including non-fatal myocardial infarction, target vessel resuscitation PCI or CABG, cardiovascular death]. Results Before and after PCI, CCSS were 3.0 ± 0.4 and 1.5 ± 0.2 (P <0.01), 3.5 ± 0.6 and 1.9 ± 0.5 (P <0.01), 1.8 ± 0.6 and 1.6 ± 0.4 (P> 0.05). NYHAS were 2.6 ± 0.3 and 1.5 ± 0.4 (P <0.01), 3.0 ± 0.9 and 2.0 ± 0.3 (P <0.01), 2 .8 ± 0.5 and 2.6 ± 0.6 (P> 0.05). EF were 45.5% ± 9.9% and 50.9% ± 10.5% (P <0.01), 44.8% ± 9.6% and 46.3% ± 8.5%, respectively P <0.01), 39.1% ± 10.2% and 40.2% ± 11.1%, respectively (P> 0.05). MACE were 4.2%, 7.1% and 13.0% (P> 0.05). Conclusion The efficacy of PCI for angina pectoris and improving cardiac function in patients with CTO lesions depends on the blood flow state and the number of viable myocardium in the distal vascular bed before PCI.