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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。
OBJECTIVE: To observe and analyze the clinical and pathological features of patients with chronic coronary artery occlusion and the effect of interventional therapy to improve the success rate and survival rate of interventional therapy in patients with coronary heart disease. Methods: A total of 104 patients with chronic coronary artery occlusion and percutaneous coronary intervention (PCI) confirmed by coronary angiography from January 2006 to January 2009 were divided into three groups. Group A: right coronary artery Artery occlusion of left anterior descending artery in 33 cases; group B: right coronary artery + left circumflex artery occlusion in 30 cases; group C: left anterior descending coronary artery + circumflex artery occlusion in 41 cases. The clinical data, PCI results, complications, cardiac function and major adverse coronary events (MACE) during follow-up were analyzed retrospectively. Results: The rate of PCI recanalization was high in each group (96%). There were fewer complications and no deaths during operation. No MACE occurred after hospitalization during the hospitalization period. No patient underwent emergency coronary artery bypass grafting (CABG) . The postoperative cardiac function (left ventricular ejection fraction) in each group was significantly improved compared with that before operation [group A: (36 ± 8)% vs (47 ± 9)%, P <0.01; group B: 8)% vs (51 ± 8)%, P <0.01; group C: (36 ± 7)% vs (45 ± 8)%, P <0.01]. The incidence of postoperative MACE at 1 year showed that the incidence of MACE in group C was higher than that in group A or group B (P <0.05), but there was no significant difference between group A and group B. Conclusions: There are few complications of PCI in patients with chronic coronary artery occlusion. The success rate of double-vessel simultaneous occlusion is high. The MACE of left anterior descending coronary artery and left circumflex artery occlusion is higher than other groups. However, PCI can significantly improve the patients with severe coronary artery occlusion Heart function, improve long-term clinical prognosis.