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目的总结并探讨无心肌梗死(MI)病史的冠状动脉慢性完全闭塞病变(CTO)冠心病患者的临床、影像学和经皮冠状动脉介入治疗(PCI)的特点。方法纳入1995年7月至2014年12月在沈阳军区总医院心内科行PCI的连续性绝对性CTO冠心病患者共2651例,其中无MI病史患者1466例(55.3%,无MI组),有MI病史患者1185例(44.7%,MI组)。结果无MI组患者年龄、女性比例、不稳定型心绞痛比例、高血压病比例、血清三酰甘油水平及左心室射血分数(LVEF)均显著高于MI组,差异均有统计学意义(均P<0.05);而无MI组患者心力衰竭比例和血肌酸酐水平均显著低于MI组,差异均有统计学意义(均P<0.001)。无MI组患者多支病变比例(81.4%比76.5%,P=0.002)高于MI组;在CTO靶血管分布方面,无MI组患者左前降支比例(36.2%比40.7%,P=0.007)显著低于MI组,而左回旋支比例(17.0%比12.7%,P<0.001)、侧支循环良好比例(32.7%比27.0%,P<0.001)显著高于MI组,差异均有统计学意义。两组患者CTO靶血管PCI成功率、完全血运重建比例、平均支架置入数、平均支架直径和平均支架总长度比较,差异均无统计学意义(均P>0.05)。结论无MI病史的CTO冠心病患者因为年龄、性别、不稳定型心绞痛反复缺血预适应、高血压病等因素,可能促进了侧支循环的建立,使心功能得到保护。
Objective To summarize and discuss the characteristics of clinical, radiological and percutaneous coronary intervention (PCI) in patients with coronary artery disease of chronic total occlusion (CTO) without coronary heart disease (MI). Methods A total of 2651 consecutive CTO patients with coronary heart disease undergoing PCI at the Shenyang Military Region General Hospital from July 1995 to December 2014 were enrolled. Among them, 1466 patients (55.3%) had no history of MI, and there were MI history of patients with 1185 cases (44.7%, MI group). Results The age, female ratio, unstable angina pectoris, hypertension rate, serum triglyceride level and left ventricular ejection fraction (LVEF) in MI group were significantly higher than those in MI group P <0.05). However, the proportion of heart failure and serum creatinine in patients without MI were significantly lower than those in MI (all P <0.001). The proportion of multi-vessel disease (81.4% vs 76.5%, P = 0.002) in MI-free patients was higher than that in MI patients. In CTO target vessel distribution, the proportion of left anterior descending (36.2% vs. 40.7%, P = 0.007) (17.0% vs. 12.7%, P <0.001). The good proportion of collateral circulation (32.7% vs 27.0%, P <0.001) was significantly higher than that of MI group, and the differences were statistically significant significance. CTO target vessel PCI success rate, complete revascularization ratio, average stent placement, average stent diameter and average stent length in both groups were not significantly different (all P> 0.05). Conclusion Patients with CTO without MI have a history of collateral circulation because of age, gender, ischemic preconditioning and unstable hypertension, which may promote the development of collateral circulation.