于军; 吕安林; 邢玉洁

摘要: 目的:观察和分析双支冠状动脉慢性闭塞病变患者的临床和病变特点及介入治疗的效果，提高危重冠心病患者的介入治疗成功率和生存率。方法：选取2006年1月～2009年1月住院经冠脉造影检查证实两支冠脉慢性闭塞并行经皮冠脉介入治疗( PCI)的患者104例，分为3组，A组：右冠状动脉+左冠状动脉前降支闭塞，33例；B组：右冠状动脉+左冠状动脉回旋支闭塞，30例；C组：左冠状动脉前降支+回旋支闭塞，41例。对患者临床资料、PCI结果、并发症、心功能和随访期间主要心血管不良事件(major adverse coronary events,MACE)等进行回顾性分析。结果：各组PCI再通率高（双支开通率占96%），并发症少，术中无死亡病例,术后住院期间无MACE发生,无患者进行急诊冠状动脉旁路移植术(CABG)。术后各组心功能（左室射血分数）均较术前有显著的改善［A组：(36±8)% vs. (47±9)%，P<0.01；B组：(41±8)% vs. (51±8)%，P<0.01；C组：(36±7)% vs. (45±8)%，P<0.01］。术后MACE发生率1年随访结果显示：C组MACE发生率高于A组或B组(P<0.05)，而A组和B组间无统计学差异。结论： PCI治疗双支冠脉慢性闭塞病变并发症少，双支同时开通成功率高，左前降支和左旋支闭塞介入治疗MACE较其它组高，但PCI治疗可显著提高重症冠状动脉闭塞患者的心功能，改善长期临床预后。

Abstract: AIM:To explore the clinical and lesion features and interventional strategies/techniques for chronic total occlusion of two major coronary arteries so as to enhance the success rate of interventional treatment and survival rate of patients with chronic total occlusion of two major coronary arteries. METHODS: From January 2004 to January 2008, 104 patients with chronic total occlusion of two major coronary arteries diagnosed by coronary artery angiography and treated with percutaneous coronary intervention (PCI) treatment were enrolled in this study. Patients were divided into three groups: group A occlusion of the right coronary plus left anterior descending coronary artery (n=33 cases), group B occlusion of the right coronary artery plus left circumflex coronary artery (n=30 cases) and group C occlusion of the left anterior descending coronary artery plus circumflex artery (n=41 cases). Clinical data, PCI results, complications, cardiac function and major adverse cardiac events (MACE) during follow-up were retrospectively analyzed. RESULTS: The success rate of interventional treatment is remarkable (96%) with a low rate of complications of interventional treatment. No deaths occurred during operation, no MACE occurred during postoperative hospitalization and no patients were treated with emergency coronary artery bypass grafting (CABG). Significant improvement in cardiac function was found in each group (group A: 36.40±8.2 vs. 47.38±8.9, P<0.01; group B: 40.76±7.8 vs. 50.86±7.5, P<0.01; group C: 35.89±7.4 vs. 45.47±8.0, P<0.01). Incidence of MACE after 1-year follow-up in group C was higher than in group A or group B (P<0.05), whereas no significant difference was found between group A and group B. CONCLUSION: The success rate of interventional treatment and survival rate of patients with chronic total occlusion of two major coronary arteries were significantly improved. Therefore, PCI treatment improves cardiac function of patients with chronic total occlusion of two major coronary arteries and enhances long-term clinical results.

Interventional strategies and techniques for chronic total occlusion of two major coronary arteries