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目的:从临床、检验及影像学特点等方面,探讨2型糖尿病患者冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)经皮冠状动脉介入治疗围手术期心肌损伤(peri-procedure myocardial injury,PMI)的预测因素分析。方法:收集复旦大学附属中山医院心脏介入中心专用数据库2013年1月至2014年12月临床诊断“冠心病”收入院的患者,选择2型糖尿病合并CTO病变患者134例。结果:研究入选134例2型糖尿病合并CTO病变患者,平均年龄(62.12±9.018)岁,其中男性占81.34%(109/134),PMI发生率为14.18%(19/134),根据是否发生围手术期心肌损伤分为围手术期心肌损伤组(19人)和围手术期非心肌损伤组(115人)。单因素分析发现:两组间开口病变、钝性残端病变、扭曲病变、病变长度>20mm、逆向导丝技术、反向CART技术、J-CTO积分均具有明显差异。Logistic多元回归分析显示:反向CART技术(OR 7.580,P<0.05)、病变长度>20mm(OR 3.642,P<0.05)是2型糖尿病患者合并CTO病变引起围手术期PMI的独立预测因素。结论:反向CART技术、病变长度>20mm是2型糖尿病合并CTO病变发生PMI的独立预测因素。预知该类特殊患者围手术期心肌损伤的风险,对心脏不良事件进行评估,从而有助于治疗策略的选择。
Objective: To investigate the perioperative myocardial injury (PMI) of percutaneous coronary intervention in patients with type 2 diabetes mellitus (DM) with chronic total occlusion (CTO) of coronary artery undergoing percutaneous coronary intervention ) Predictors of factor analysis. Methods: A total of 134 patients with type 2 diabetes mellitus and CTO lesions were selected from the hospital for clinical diagnosis of “coronary heart disease” from January 2013 to December 2014 in the dedicated database of cardiac intervention center of Zhongshan Hospital, Fudan University. Results: The study selected 134 cases of type 2 diabetes with CTO lesions, the average age (62.12 ± 9.018) years, of which 81.34% (109/134) of men, PMI was 14.18% (19/134), according to whether the occurrence of Wai The myocardial damage during operation was divided into perioperative myocardial injury group (19 persons) and perioperative non-myocardial injury group (115 persons). Univariate analysis showed that open lesions, blunt stump lesions, twisted lesions, pathological lesions> 20mm in length, reverse guidewire technique, reverse CART technique and J-CTO integral were significantly different between the two groups. Logistic multivariate regression analysis showed that reverse CART technique (OR 7.580, P <0.05) and lesion length> 20 mm (OR 3.642, P <0.05) were independent predictors of perioperative PMI in type 2 diabetic patients with CTO lesions. CONCLUSION: Inverse CART technique, with a length of> 20 mm, is an independent predictor of PMI in type 2 diabetic patients with CTO. Predict the risk of perioperative myocardial injury in this particular group of patients and assess cardiac adverse events to aid in the choice of treatment strategy.