Dissertation
Dissertation > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)

Assessment of Clinical, Angiographic Features and Determinants of Percutaeous Coronary Intervention in Patients with Coronary Artery Chronic Total Occlusion

Author LiChenGuang
Tutor GeJunBo;LiuXueBo
School Fudan University
Course Cardiovascular within science
Keywords Coronary chronic total occlusion Percutaneous coronary intervention treatment Coronary artery bypass grafting
CLC R541.4
Type Master's thesis
Year 2009
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Objective: To evaluate coronary chronic total occlusion lesions (Chronic coronary arterial totalocclusion, CTO) clinical and imaging characteristics, and to explore the related factors that affect treatment strategies and percutaneous coronary intervention treatment (Percutaneous coronary intervention, PCI) surgery success rate. Methods: Consecutive collected from January 2004 to December 2008 due to the clinical diagnosis of coronary heart disease \Retrospective analysis of clinical images and PCI of CTO target lesion surgery information and compare. Measurement data to analysis of variance and independent sample t test was used to compare the count to the chi-square test or Fisher exact test was used to compare. Logistic regression analysis of the CTO lesions therapeutic strategy and PCI success rate of surgery related factors. Results: The average age of the 638 patients was 64.1 ± 11.0 years, male, 538 cases (84.3%); 447 cases (70.1%) underwent PCI, CABG surgery or medical therapy alone in 191 patients (29.9%). PCI success group (382/447, 85.5%), 96.9% (370 cases) implantation of drug-eluting stents, 3.1% (12 cases) bare-metal stent implantation, the average number of stents implantation 1.9 ± 0.8 Mei, planting into the stent length of 55.6 ± 20.4mm. Intervention in the failure group (65/447, 14.5%), 73.9% (48/65) for the guide wire failed (unable to occlusion or unable to determine the true lumen), 15.4% (10/65) the failed balloon (2 lesions, eight cases of cases of balloon can not can not expand lesions), 10.8% (n = 7) to give up intervention for patients unable to tolerate or serious complications. Surgery, severe coronary artery dissection (CF) 17 cases (3.8%), coronary perforation in 10 cases (2.2%); postoperative pericardial tamponade in 6 patients (1.3%), acute stent thrombosis in 1 case (0.22%), died in hospital two cases (0.44%). (1) PCI group compared with the non-PCI group, the former older (63.4 ± 10.4 vs.65.7 ± 12.0.P lt; 0.05), chest pain longer (168.1 ± 224.4 weeks vs.280.8 ± 291.0 weeks in P lt; 0.05), low-density lipoprotein cholesterol (LDL-C) level higher (2.3 ± 1.0mmol/Lvs.2.6 ± 1.2 mmol / L, P lt; 0.01), but the incidence of diabetes in the two groups no statistically significant The difference (25.5% vs.23.6%, P = 0.603). Meanwhile, the image data further suggest the PCI group, severe vascular tortuosity of the proximal segment (19.5% vs.29.8%, P lt; 0.01), closed end was \), openings occlusion (22.4% Vs.32.5%, P lt; 0.01), lesion calcification (42.1% vs.57.1%, P lt; 0.01), merged three lesions (32.2% vs.63.4%, P lt; 0.01), the relatively low incidence of the left main coronary artery disease (0.9% vs.11.5%, P lt; 0.01), target vessel occlusion (4.3% vs.19.9%, P lt; 0.01). Logistic regression analysis further showed that chest pain for more than 3 years (OR: 0.998,95% CI :0.997-1 .000 P lt; 0.01) opening occlusive lesions (OR: 0.288,95% CI, :0.172-0 .482 P lt ; 0.01), the combined three-vessel disease (OR: 0.288 95% CI :0.172-0 .482, P lt; 0.01) for CTO lesions whether to attempt an independent negative predictor of interventional treatment. (2) on the PCI subgroup analysis, age in the failure group (62.87 ± 10.39 vs.65.92 ± 9.91, P LT; 0.05) is relatively high, as well as the proximal vascular severe tortuosity (16.2% vs.38.5%, P LT ; 0.01), closed end was \%,, P lt; 0.01), and not use micro-catheters, the preferred non-hydrophilic or tapered guide wire; merger multivessel disease, puncture pathway and whether bilateral contrast, no significant difference. Logistic regression analysis, age greater than 65 years of age (P lt; 0.05, 0 R: 0.949,95% CI :0.906-0 .995), high triglycerides (OR: 0.038,95% CI :0.148-0 .949, P lt; 0.05), lesion calcification (OR: 253,95% CI :0.108-0 .592, P lt; 0.01), a serious disease into a corner (OR: 0.167,95% CI :0.062-0 .451, P lt; 0.001) and knife shaped morphology (OR: 0.223, P lt; 0.001,95% CI :0.089-0 .561) to interventional treatment success for CTO lesions independent negative predictive factors. Conclusions: 1) The single-center five years involved in the treatment of CTO success rate was 85.5%, compared to the same period in his center a higher success rate; hospital cardiac tamponade and MACE event rate of 1.79%, suggesting that percutaneous interventional treatment of coronary chronic fully occlusion is a relatively safe and effective. 2) The study found that the time of chest pain greater than 3 years, opening occlusion merge three lesions CTO lesions whether to try the independent negative predictor of interventional treatment, combined with a high success rate in the PCI group, so patients should be weighed against the clinical factors and lesion characteristics individualized treatment strategies. 3) Notwithstanding the center of the treatment strategy relative individualized, but age gt; 65-year-old, high triglycerides, lesion calcification, severe angle occlusion and \

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