本文選題：慢性完全閉塞病變　切入點(diǎn)：介入治療　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：背景：慢性完全閉塞病變(CTO)在冠心病中發(fā)生率高,而目前經(jīng)皮冠狀動(dòng)脈介入治療(PCI)率仍低,除了受到技術(shù)難度和操作風(fēng)險(xiǎn)的限制,CTO-PCI臨床獲益的不確定性亦對(duì)治療決策的選擇造成困擾。雖然多數(shù)大型觀察性研究已肯定了CTO-PCI的長(zhǎng)期療效,但仍不乏反對(duì)聲音。隨著介入技術(shù)的日新月異,對(duì)于CTO-PCI臨床獲益的結(jié)論需要與技術(shù)更新同步的數(shù)據(jù)支持。此外,已有前人研究提出CTO-PCI的生存獲益因目標(biāo)血管的不同而存在差異。本研究立足于明確CTO-PCI的長(zhǎng)期臨床獲益,并嘗試探討開通不同部位CTO病變對(duì)于療效影響的差異性。 方法：本研究收集了2006年9月至2011年12月,浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院心內(nèi)科收治的209名嘗試經(jīng)介入治療開通單支CTO病變的患者信息,并排除了存在1月內(nèi)急性心梗、左主干或橋血管慢性閉塞以及含多個(gè)CTO病變的患者。209人中,有183人通過了至少36個(gè)月的長(zhǎng)期隨訪。本研究以主要不良心血管事件(MACE)(包括全因死亡、非致死性心梗和緊急目標(biāo)血管血運(yùn)重建)作為聯(lián)合觀察終點(diǎn),比較了CTO-PCI成功與否對(duì)患者無MACE生存時(shí)間和擇期再次血運(yùn)重建的影響。 結(jié)果：209名患者中,右冠狀動(dòng)脈(RCA)病變者101人(48.3%),左前降支(LAD)病變者62人(29.7%),左回旋支(LCX)病變者有46人(22.0%)RCA CTO患者高血壓發(fā)病率和既往行PCI治療率更高,而LAD CTO患者中男性和吸煙者所占比例大。從冠脈造影特點(diǎn)來看,RCA CTO合并三支病變(80.2%vs.29.0%vs.66.0%, P0.001)及側(cè)枝循環(huán)開放(72.2%vs.59.7%vs.42.0%,P=0.001)的比例顯著高于LAD和LCX組。患者的總體造影成功率為79.4%,手術(shù)操作成功率為75.4%,不同目標(biāo)血管分組間在造影和手術(shù)操作成功率上無顯著差異。在平均44.6個(gè)月的隨訪中,手術(shù)操作成功能顯著改善總體患者的無MACE生存時(shí)間(P0.001)。不同病變部位的亞組之間比較,僅RCA CTO患者PCI術(shù)顯著延長(zhǎng)無MACE生存時(shí)間(P0.001),而非RCA組中并無統(tǒng)計(jì)學(xué)差異(P=0.053)。經(jīng)過Cox多元回歸分析,手術(shù)操作成功仍是RCA CTO患者長(zhǎng)期MACE的獨(dú)立預(yù)測(cè)因子(HR3.30,95%CI:1.30-8.39, P=0.012) 結(jié)論：本研究結(jié)果提示CTO-PCI能顯著改善長(zhǎng)期無MACE生存情況,尤其對(duì)RCA病變患者獲益更大。這一結(jié)論將有助于優(yōu)化CTO-PCI的患者選擇。
[Abstract]:Background: the incidence of chronic total occlusive lesions (CTO) in coronary heart disease is high, but the rate of percutaneous coronary intervention (PCI) is still low. In addition to being limited by technical difficulties and operational risks, the uncertainty of the clinical benefits of CTO-PCI also bothers the choice of treatment decisions, although most large observational studies have confirmed the long-term efficacy of CTO-PCI. But there is still a lot of opposition. With the rapid development of interventional techniques, conclusions about the clinical benefits of CTO-PCI need to be supported by data that are synchronized with technical updates. Previous studies have suggested that the survival benefits of CTO-PCI vary with the target vessels. This study is based on the long-term clinical benefits of CTO-PCI and attempts to explore the difference of the effect of opening different sites of CTO lesions on the efficacy. Methods: from September 2006 to December 2011, we collected information of 209 patients who were admitted to Department of Cardiology, affiliated to run run run Shaw Hospital, Zhejiang University Medical College, and excluded the presence of acute myocardial infarction within January. Of the .209 patients with chronic occlusion of the left main or graft vessels and with multiple CTO lesions, 183 passed at least 36 months of long-term follow-up. Non-fatal myocardial infarction and emergency target vascular revascularization) were used as the combined observation endpoints to compare the effects of CTO-PCI success on the survival time without MACE and recurrent revascularization. Results among the 209 patients, 101 patients had right coronary artery stenosis (RCA), 62 had left anterior descending artery (lad) lesions, and 46 had left circumflex branch (LCX) lesions. The incidence of hypertension and the rate of previous PCI treatment were higher in 46 patients with RCA CTO. However, the proportion of male and smoker in LAD CTO patients was higher than that in LAD and LCX groups. The ratio of RCA CTO with three vessel lesions was 80.2 vs 29.0vs.66.0 (P0.001) and 72.2 vs.59.7vs.42.0vs.42.0P0.001). The overall successful rate of angiography was 79.4%. The operative success rate was 75.4, and there was no significant difference between different target vessel groups in angiographic and operative success rates. The successful operation could significantly improve the survival time without MACE of the overall patients (P 0.001). Only PCI in patients with RCA CTO significantly prolonged the survival time without MACE (P 0.001), but there was no statistical difference in the non-#en4# group. By Cox multiple regression analysis, the success of the operation was still the independent predictor of long-term MACE in RCA CTO patients (HR3.30 ~ 95% CI: 1.30-8.39, P0. 012). Conclusion: the results of this study suggest that CTO-PCI can significantly improve the long-term MACE free survival, especially for the patients with RCA lesions. This conclusion will be helpful to optimize the choice of CTO-PCI patients.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

【共引文獻(xiàn)】

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本文編號(hào)：1596037