青年冠状动脉慢性完全闭塞患者临床、血管造影和经皮冠状动脉介入治疗特点

摘要

目的 探讨不同年龄段冠状动脉慢性完全闭塞(chronic total occlusions,CTO)病变患者的临床、影像学及经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的特点.方法 回顾性分析北部战区总医院心内科2009年1月至2014年12月连续收治行PCI的CTO患者1951例.按年龄分为青年组(≤44岁)117例、中年组(45～59岁)773例和老年组(≥60岁)1061例.患者临床特征、冠状动脉造影结果、PCI相关资料及住院结果均来源于我院心内科冠心病PCI数据库.结果 青年组、中年组和老年组患者在男性比例(100.0％比91.2％比66.4％,P<0.001)、体重指数[(26.9±3.6)kg/m2比(26.3±5.0)kg/m2比(25.2±3.7)kg/m2,P<0.001]、吸烟者比例(73.5％比68.6％比47.2％,P<0.001)、饮酒者比例(45.3％比43.9％比27.0％,P<0.001)、肌酐清除率[(129.6±34.5)ml/min比(110.2±32.7)ml/min比(83.7±28.6)ml/min,P<0.001]、血三酰甘油[(2.75±2.88)mmol/L比(2.52±2.27)mmol/L比(1.96±1.32)mmol/L,P<0.001]、低密度脂蛋白胆固醇[(2.61±1.19)mmol/L比(2.36±0.95)mmol/L比(2.32±0.89)mmol/L,P=0.011]等方面比较,差异均有统计学意义,且青年组均为最高值;而不稳定型心绞痛者比例(61.5％比78.8％比75.1％,P<0.001)、高血压病者比例(52.1％比54.5％比66.1％,P<0.001)及卒中病史者比例(0.0比6.3％比10.0％,P<0.001)比较,差异均有统计学意义,但青年组均为最低值;病变血管支数[(2.19±0.76)支比(2.19±0.77)支比(2.30±0.73)支,P=0.005]及CTO闭塞时间[(11.7±2.8)个月比(26.3±8.6)个月比(26.7±8.4)个月,P=0.002]比较,差异均有统计学意义,且青年组均为最低值;靶血管成功率(86.8％比89.0％比84.1％,P=0.009)、完全血运重建率(40.2％比36.6％比31.5％,P=0.026)和平均支架直径[(2.90±0.28)mm比(2.84±0.28)mm比(2.82±0.28)mm,P=0.018]比较,差异均有统计学意义.三组患者CTO血管分布、侧支循环Rentrop分级值、CTO病变长度、CTO病变直径和CTO病变特征(刀切状CTO、CTO存在桥侧支和CTO病变近端有分支)、对比剂剂量、CTO手术时间、平均支架数和平均支架长度方面比较,差异均无统计学差异(均P>0.05).结论 青年CTO患者具有典型的传统冠心病危险因素,且可能由于病史时间较短,使其具有较高的靶血管成功率和完全血运重建率.冠心病危险因素的控制应贯彻于疾病预防的始终.%Objective To investigate the characteristics in clinical, angiographic and percutaneous intervention (PCI) aspects of patients with chronic total occlusion (CTO) across different age groups, especially in young patients. Methods This study retrospectively analyzed 195 cases of CTO lesions admitted to the Department of Cardiology, General Hospital of Northern Theater Command from 2009 to 2014. These 1951 patients with CTO had undergone PCI and were divided into the young CTO group (≤44 years), the middle-aged CTO group (45-59 years) and the senior CTO group (≥60 years) according to their age. All patients had objective evidence of angina pectoris or myocardial ischemia before PCI. All the clinical features, coronary angiographic results, PCI related data and hospitalization outcome were all derived from our hospital PCI archives. Results There were significant differences in male ratio, body mass index, smoking and, drinking habit, creatinine clearance, triglyceride and LDL levels across the three groups (all P<0.05), and the highest values were found in the young patient group. The prevalence of unstable angina pectoris, hypertension and stroke were lowest in the young patient group (all P<0.05). The number of stenotic vessels and CTO occlusion time were less in young patients (all P <0.05). There was no significant difference among the three groups in CTO vascular distribution, coronary collateral Rentrop degree, CTO lesion length, CTO lesion diameter and CTO lesion characteristics (blunt CTO, CTO with bridging collateral and proximal branch of CTO lesion). There were no significant differences among the three groups in the volume of contrast agent used, CTO operation time, average stent number and average stent length (P>0.05). The procedural success rate of target vessels, races complete revascularization and mean stent diameter were highest in the young patient group (P<0.001).Conclusions Young CTO patients had typical risk factors of coronary heart disease with higher PCI success rate to target vessels and complete revascularization rate, which may be related to the short history of CTO.