Effect of previous coronary artery bypass graft on percutaneous coronary intervention in patients with chronic total occlusion
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摘要: 目的 比较既往有冠状动脉旁路移植术(CABG)和既往无CABG对原位血管慢性完全闭塞(CTO)病变行经皮冠状动脉介入治疗(PCI)的影响。方法 选择2016年10月—2021年12月就诊于辽宁省人民医院接受CTO-PCI术且既往有CABG的患者82例作为病例组，采用1︰2匹配病例-对照研究方法，选择相同术者同期手术既往无CABG的CTO-PCI患者164例作为对照组，匹配的条件是性别相同，年龄±3岁。比较两组患者的基线资料、手术成功率和住院并发症等。结果 既往有CABG组患者高血压病(73.2%∶57.9%，P=0.020)、高脂血症(40.2%∶27.4%，P=0.042)、糖尿病(48.8%∶35.4%，P=0.043)和卒中史(11.0%∶3.7%，P=0.024)明显高于既往无CABG组。既往有CABG组患者钙化(61.0%∶37.8%，P=0.001)、闭塞节段成角≥45°(63.4%∶37.8%，P＜0.001)、闭塞长度>20 mm(56.1%∶39.0%，P=0.011)明显高于对照组，且J-CTO评分[(2.5±0.9)分∶(1.8±0.9)分，P＜0.001]及≥3分的比例更高(48.8%∶30.5%，P=0.005)。既往有CABG组患者应用逆向技术(46.3%∶26.2%，P=0.002)比例更高，但技术成功率(89.0%∶95.7%，P=0.044)、手术成功率(80.5%∶90.9%，P=0.021)均明显低于既往无CABG组，而围术期心肌损伤(6.1%∶0.6%，P=0.028) 显著高于既往无CABG组。两组在其他并发症方面比较，差异均无统计学意义。结论 与既往无CABG组相比，既往有CABG组的患者病变更复杂，更多地使用逆向技术，技术及手术成功率均更低，但两组的并发症相似。
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关键词:
- 冠状动脉慢性完全闭塞 /
- 冠状动脉旁路移植术 /
- 经皮冠状动脉介入治疗
Abstract: Objective To compare the effects of previous coronary artery bypass graft(CABG) and previous non-CABG on percutaneous coronary intervention(PCI) in patients with chronic total occlusion(CTO).Methods A total of 82 patients with CABG underwent CTO-PCI were selected as the case group in Liaoning Provincial People's Hospital from October 2016 to December 2021. A 1: 2 matched case-control study was conducted. The 164 patients with CTO-PCI who underwent the same operation in the same period were selected as the control group. The matching conditions were the same sex and age ±3 years old. The baseline data, operation success rate and hospitalization complications were compared.Results Compared with the patients without prior CABG, the patients with prior CABG had more hypertension(73.2% vs 57.9%,P=0.020)、hyperlipidemia(40.2% vs 27.4%,P=0.042)、diabetes(48.8% vs 35.4%,P=0.043) and stroke history(11.0% vs 3.7%,P=0.024). The patients with previous CABG had more complicated CTO lesions: calcification(61.0% vs 37.8%,P=0.001), occlusive segment angulation ≥ 45 °(63.4% vs 37.8%,P< 0.001), occlusion length>20 mm(56.1% vs 39.0%,P=0.011), and higher J-CTO score(2.5±0.9 vs 1.8±0.9 scores,P< 0.001) and higher proportion of ≥ 3 scores(48.8% vs 30.5%,P=0.005). The use of reverse technology in patients with prior CABG(46.3% vs 26.2%,P=0.002) was significantly higher than that in the control group. However, the technical success rate(89.0% vs 95.7%,P=0.044) and surgical success rate(80.5% vs 90.9%,P=0.021) in the previous CABG group were significantly lower than those in the previous group without CABG, while the perioperative myocardial injury(6.1% vs 0.6%,P=0.028) was significantly higher than that in the previous group without CABG. There was no significant difference in other complications between the two groups.Conclusion Compared with the patients without prior CABG, the patients with prior CABG had more complex lesions, more use of retrograde techniques, and lower success rates of technique and operation, but the complications of the two groups were similar. -
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表 1 两组一般临床资料比较
Table 1. General data
X±S 项目 既往有CABG组(82例) 既往无CABG组(164例) P值 年龄/岁 65.3±5.2 65.2±5.2 NA 男性/例(%) 68(82.9) 136(82.9) NA BMI/(kg·m-2) 28.3±1.4 28.0±1.6 0.107 高血压病/例(%) 60(73.2) 95(57.9) 0.020 高脂血症/例(%) 33(40.2) 45(27.4) 0.042 糖尿病/例(%) 40(48.8) 58(35.4) 0.043 家族史/例(%) 10(12.2) 16(9.8) 0.557 吸烟史/例(%) 13(15.9) 33(20.1) 0.418 心力衰竭史/例(%) 19(23.2) 36(22.0) 0.829 LVEF＜40%/例(%) 16(19.5) 34(20.7) 0.823 陈旧性心肌梗死/例(%) 30(36.6) 53(32.3) 0.504 PCI史/例(%) 26(31.7) 48(29.3) 0.694 卒中/例(%) 9(11.0) 6(3.7) 0.024 
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表 2 两组患者的造影特征比较
Table 2. Angiographic characteristics
例(%), X±S 项目 既往有CABG组(82例) 既往无CABG组(164例) P值 手术入路 单桡入路 4(4.9) 18(11.0) 0.114 单股入路 2(2.4) 3(1.8) 1.000 双桡入路 30(36.6) 79(48.2) 0.085 双股入路 5(6.1) 3(1.8) 0.162 桡和股入路 41(50.0) 61(37.2) 0.055 既往PCI失败史 11(13.4) 26(15.9) 0.614 钙化 50(61.0) 62(37.8) 0.001 闭塞节段成角≥45° 52(63.4) 62(37.8) ＜0.001 闭塞长度>20 mm 46(56.1) 64(39.0) 0.011 钝头样闭塞残端 48(58.5) 81(49.4) 0.176 J-CTO评分/分 2.5±0.9 1.8±0.9 ＜0.001 J-CTO评分≥3分 40(48.8) 50(30.5) 0.005 Rentrop分级0~1级 53(64.6) 99(60.4) 0.516
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表 3 两组患者的手术结果比较
Table 3. Surgery result
例(%), X±S 项目 既往有CABG组(82例) 既往无CABG组(164例) P值 CTO病变靶血管 RCA 45(54.9) 87(53.0) 0.786 LCX 23(28.0) 36(22.0) 0.291 LAD 13(15.9) 41(25.0) 0.102 左主干/移植血管 1(1.2) 0(0) 0.333 血运重建 应用正向导丝升级 44(53.7) 121(73.8) 0.002 应用逆向技术 38(46.3) 43(26.2) 应用逆向技术的侧支血管 间隔支 65(79.3) 148(90.2) 0.017 心外膜侧支 16(19.5) 16(9.8) 0.032 旁路移植血管 1(1.2) 0(0) 0.333 总手术时间/min 131±18 112±16 ＜0.001 总透视时间/min 67±11 57±9 ＜0.001 对比剂用量/mL 291±34 245±20 ＜0.001 IVUS 9(11.0) 17(10.4) 0.883 技术成功率 73(89.0) 157(95.7) 0.044 手术成功率 66(80.5) 149(90.9) 0.021
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表 4 两组患者的并发症比较
Table 4. Complication in two groups
例(%) 项目 既往有CABG组(82例) 既往无CABG组(164例) P值 心包填塞 1(1.2) 3(1.8) 1.000 原位冠状动脉穿孔 2(2.4) 3(1.8) 1.000 侧支冠状动脉穿孔 1(1.2) 0(0) 0.333 侧支血肿 2(2.4) 1(0.6) 0.538 供血血管夹层 1(1.2) 1(0.6) 1.000
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表 5 两组患者的MACCE比较
Table 5. MACCE in two groups
例(%) 项目 既往有CABG组(82例) 既往无CABG组(164例) P值 死亡 1(1.2) 2(1.2) 1.000 卒中 2(2.4) 2(1.2) 0.859 围术期心肌损伤 5(6.1) 1(0.6) 0.028 紧急靶血管重建 0(0) 3(1.8) 0.538
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