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目的探讨非梗死相关血管合并慢性完全闭塞病变(CTO)是否增加冠状动脉多支病变的急性心肌梗死患者住院期间风险,及风险是来源于CTO病变自身抑或是同时存在的其他危险因素。方法回顾性分析2005年9月-2007年12月期间连续入院接受急诊经皮冠状动脉介入治疗(PCI)合并冠状动脉多支病变的ST段抬高心肌梗死(STEMI)患者。比较合并及不合并CTO病变的冠状动脉多支病变患者的临床及急诊介入手术资料,采用Logistic回归进行多因素分析,确定发生住院期间主要心脏不良事件(MACE)的独立危险因素。结果接受急诊PCI的冠状动脉多支病变STEMI患者185例,其中合并CTO病变(CTO)组20例(10.8%)。住院期间,CTO组的冠状动脉三支病变发生率为65.0%,显著高于无合并CTO病变(无CTO)组的37.6%(P=0.02);急诊PCI术后梗死相关血管恢复心机梗死溶栓试验(TIMI)血流3级的构成比为85.0%,显著低于无CTO组的93.3%(P=0.01);左心室射血分数(LVEF)为0.511±0.120,显著低于无CTO组的0.582±0.995(P=0.02);MACE发生率为30.0%,显著高于无CTO组的10.9%(P=0.02)。CTO病变不是冠状动脉多支病变患者发生住院期间MACE的独立危险因素。结论合并CTO病变的STEMI患者的冠状动脉病变更为广泛及严重,急诊PCI术后发生无复流的风险增加,因此导致住院期间发生MACE的风险增大,但它不是影响短期预后的独立危险因素。此外,合并CTO病变患者的左心室功能明显减低,提示长期预后不良。
Objective To investigate the risk factors of hospitalized patients with non-infarction-related vascular combined chronic total occlusion (CTO) and coronary heart disease (MI) with coronary heart disease (MI) and other risk factors of CTO. Methods We retrospectively analyzed STEMI patients admitted to our hospital from September 2005 to December 2007 undergoing percutaneous coronary intervention (PCI) with multiple coronary lesions. The clinical and emergency interventional data of patients with coronary artery disease complicated with or without CTO were compared. Logistic regression was used to analyze multivariate analysis to determine the independent risk factors of major cardiac adverse events (MACE) during hospitalization. Results A total of 185 STEMI patients undergoing PCI were enrolled in this study. Twenty patients (10.8%) were complicated by CTO. During hospitalization, the incidence of coronary artery disease in CTO group was 65.0%, significantly higher than that in non-CTO group (37.0%) (P = 0.02); infarction-related vascular resuscitation after emergency PCI The ratio of blood flow grade 3 in TIMI was 85.0%, which was significantly lower than 93.3% (P = 0.01) in no CTO group and 0.511 ± 0.120 in left ventricular ejection fraction (LVEF) 0.582 ± 0.995 (P = 0.02). The incidence of MACE was 30.0%, which was significantly higher than that of non-CTO group (P = 0.02). CTO lesion is not an independent risk factor for MACE during hospitalization in patients with coronary artery disease. Conclusions The incidence of coronary artery disease in STEMI patients with CTO lesions is more extensive and severe. The increased risk of no-reflow occurred after emergency PCI, resulting in an increased risk of MACE during hospitalization. However, it is not an independent risk factor for short-term prognosis . In addition, patients with CTO lesions significantly reduced left ventricular function, suggesting that long-term prognosis is poor.