治疗时机差异对行择期PCI术冠状动脉完全闭塞病人治疗成功率、特殊技术使用率及MACE的影响
摘要
目的探讨治疗时机差异对行择期经皮冠状动脉介入术(PCI)冠状动脉完全闭塞病人治疗成功率、特殊技术使用率及主要不良心血管事件(MACE)的影响。方法选取我院2014年3月—2016年3月收治的择期行PCI术冠状动脉完全闭塞病人100例,根据治疗时机差异分为两组,A组(58例)于闭塞2～12周进行治疗;B组(42例)于闭塞12周后进行治疗。比较两组病人治疗成功率、围术期并发症发生率、导丝使用数目、支架使用数目、造影剂使用量、介入手术时间、特殊技术使用率及MACE发生率。结果 A组治疗成功率明显高于B组(P <0.05);两组围术期并发症发生率比较差异无统计学意义(P>0.05);两组导丝使用数目和支架使用数目比较差异无统计学意义(P>0.05);A组造影剂使用量及介入手术时间均明显优于B组(P <0.05);B组特殊技术使用率明显高于A组(P <0.05);同时B组术后MACE发生率明显低于A组(P <0.05)。结论早期行择期PCI术用于冠状动脉完全闭塞病人可有效提高治疗成功率,减少造影剂用量、介入手术时间及特殊技术使用率,但可能增加MACE发生风险。
引文
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[16]YOO S H,YOO T K,LIM H S.Index of microcirculatory resistance as predictor for microvascular functional recovery in patients with anterior myocardial infarction[J].J Korean Med Sci,2012,27(9):1044-1050.
[2]MICHAEL T T,MOGABGAB O,FUH E,et al.Application of the"hybrid approach"to chronic total occlusion interventions:a detailed procedural analysis[J].J Interv Cardiol,2014,27(3):36-43.
[3]SEILER C.Assessment and impact of the human coronary collateral circulation on myocardial ischemia and outcome[J].Circ Cardiovasc Interv,2013,6(6):719-728.
[4]WOSIK J,SHORROCK D,CHRISTOPOULOS G,et al.Systematic review of the bridgepoint system for crossing coronary and peripheral chronic total occlusions[J].J Invasive Cardiol,2015,27(6):269-276.
[5]KIM E K,CHOI J H,SONG Y B.A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction[J].Am Heart J,2016,171(1):56-63.
[6]MULLIN M K.Transradial approach versus transfemoral approach for coronary angiography and coronary angioplasty[J].Crit Care Nurs Q,2014,37(2):159-169.
[7]CREA F,CAMICI P G,BAIREYMERZ C N.Coronary microvasculardysfunction:an update[J].Eur Heart J,2014,35(17):1101-1111.
[8]MORENO R,GARCA E,TELES R,et al.Randomized comparison of sirolimus-eluting and everolimus-eluting coronary stents in the treatment of total coronary occlusions:results from the chronic coronary occlusion treated by everolimus-eluting stent randomized trial[J].Circ Cardiovasc Interv,2013,6(1):21-28.
[9]QIN X,XIONG W,WANG L,et al.Clinical investigation of transradial access for emergent percutaneous coronary intervention in patients with acute myocardial infarction[J].Clin Interv Aging,2013,8(Suppl 3):1139-1142.
[10]GEORGE S,COCKBURN J,CLAYTON T C,et al.Long-term follow-up of elective chronic total coronary occlusion angioplasty:analysis from the U.K.Central Cardiac Audit Database[J].J Am Coll Cardiol,2014,64(3):235-243.
[11]MALAIAPAN Y,LEUNG M,AHMAR W,et al.Guideline recommended door-to-balloon time can be achieved in transradial primary PCI-the usefulness of a dedicated radial guide catheter[J].Cardiovasc Revasc Med,2013,14(1):27-31.
[12]NG M K,YONG A S,HO M,et al.The index of microcirculatory resistance predicts myocardial infarction related to percutaneous coronary intervention[J].Circ Cardiovasc Interv,2012,5(4):515-522.
[13]JINNOUCHI H,SAKAKURA K,WADA H,et al.Transradial percutaneous coronary intervention for acute myocardial infarction reduces CCU stay in patients 80 or older[J].Int Heart J,2012,53(2):79-84.
[14]WIMMER N J,RESNIC F S,MAURI L,et al.Risk-treatment paradox in the selection of transradial access for percutaneous coronary intervention[J].J Am Heart Assoc,2013,2(3):e000174.
[15]FEARON W F,LOW A F,YONG A S,et al.Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention[J].Circulation,2013,127(24):2436-2441.
[16]YOO S H,YOO T K,LIM H S.Index of microcirculatory resistance as predictor for microvascular functional recovery in patients with anterior myocardial infarction[J].J Korean Med Sci,2012,27(9):1044-1050.