Clinical And Angiographic Analysis Of Chronic Total Occlusion Of Coronary Artery

BackgroundCoronary heart disease(CHD) is the most common type of atherosclerotic organ lesion.CHD is a serious cardiovascular disease which threatens to human health and life.The incidence of CHD is gradually increasing yearly.CHD in many countries is the most common cause of disability and even death.In 1977 Gruentzig undertook the first percutaneous transluminal coronary angioplasty,which pulled away the prologue of interventional therapy in CHD.In recent 30 years,the percutaneous coronary intervention therapy was developing at full speed.With the improvement of coronary artery intervention device designed and manufacture technical,medicine therapy and accessory equipment,complicated processing of coronary artery intervention now are becoming more safer.Chronic total occlusion(CTO) is common lesions in patients with CHD,which CAG shows no contrast media(thrombolysis in myocardial infarction,TIMI0) or little media(TIMI1),having the 20%～40%ratio of coronary artery angiography(CAG), around 10%-20%ratio of PTCA.CTO is the common type of CHD,which rule medicine therapy can not reduce the risk of artery occlusion,and the incidence rate is higher than unocclusion patient.Because of thrombus organization and obviously calcification,operator can not understand the length and diatal end of CTO,so the operation achievement ratio is lower,time of operating is longer,and more ray accepted,more materials wasted,more money spent,and restenosis rate is 45%～74%. Therefore clinical procedure of CTO is hotpot and nodus of intervention cardiology. ObjectiveTo analyse the clinical and imaging characteristics of coronary heart disease patients with chronic total occlusion(CTO) lesions shown by coronary angiography。MethodsThe data from 513 patients admitted between July 2007 and April 2008 at the First Clinical Medical School of Zhengzhou University Cardiology Department were undergone retrospective analysis.Admission diagnosis and medical history:83 cascs of no angina(16.2%),unstable angina(UAP) 289 cascs(56.3%),stable angina pectoris(SAP) 141 cases(27.6%);old myocardial infarction(OMI) 109 cases (21.3%),no OMI 404 cases(78.7%).All patients' history were above 1 month,with an average history(36.4±27.3) months.Patients according to CAG by the involved CTO vascular quantity were divided into single,double and three lesions group. Patients according to coronary heart disease risk factors,course and ejection fraction were divided into diabetes,hypertension,smoking,duration≥1 year and LVEF＜50%group,respectively,compared with its control group CTO imaging features. All statistic work was carried out with software of SPSS 13.0.The enumeration data were shown by rate.Thc rate of analysis between groups was performed by chi square test.The measurement data were shown by((?)±s).A value of P＜0.05 was considered statistically significant.Results1.There were 715 CTO vessels in 513 patient's aged 25～86(57.9±11.5) years old,accounted for the same period thc number of CAG-positive cases 30.1% (513/1529),represented the number of positive vasculars 20.2%(715/3540).Among them,81.5%of the patients were male.There were 56.3%of the patients with UAP, 21.3%with OMI and 44.8%of them smoked.In terms of comorbidity,50.3%of the patients had hypertension,21.1%with diabetes and 22.0%with hyperlipkdemia.2.Analysis of the coronary angiography showed that among all the CTO lesions,54 cases with left-dominant(10.5%),374 cases with right-dominant(72.9%),85 cases with balanced type(16.6%).3.121 cases with single-vessel disease(23.6%),165 cases with double-vessel disease(32.2%),227 cases with three-vascular disease(44.2%);333 cases with single-CTO(64.9%),170 cases with double-vessel CTO(33.1%),10 cases with three-CTO(2.0%).4.one of 6 cases with left main(LM,0.8%),265 cases with anterior descending artery(LAD,37.1%),143 cases with left circumflex artery(LCX,20%),215 cases with right coronary artery(RCA,30.1%),other blood vessel 86(12.0%)cases, including 28 cases with the obtuse marginal branch(3.9%),10 cases with posterior descending branch(1.4%),10 cases with left ventricular posterior Extension(1.4%), 48 cases with diagonal branch(6.7%).5.Among the cases:Complete occlusion(TIMI0) 651(91.2%) cases,functional occlusion(TIMI1) 64(8.8%) cases.35.4%with bridge collateral perfusion,32.9%of them were abrupt occlusion and 60%with occlusion length≥15 mm.There were 40%of the lesions showed moderate proximal segment tortuosity and 18.9%showed moderater to heavy calcification.In terms of the lesions location,30.1%was bifurcation.6.CTO images in patients with Diabete have showed complete occlusion,collateral Bridge occlusion,paragraph≥15 mm occlusion and many teams occlusion higher than non-diabetic patients.7.CTO images in patients with hypertension have shown complete occlusion and collateral bridge higher than CTO patients with non-hypertension.8.CTO images in patients with Smoking have shown complete occlusion,collateral Bridge occlusion and many teams occlusion higher than non-smoking patients.9.OMI group of patients with CTO images have shown the bridge collateral occlusion,abrupt occlusion,paragraph≥15 mm occlusion and many teams occlusion higher than the proportion of patients with non-OMI Group.10.Duration≥1 year in patients with CTO images have shown complete occlusion and many teams occlusion higher than the＜1 year in patients.The ratio of abrupt occlusion and is lower than duration＜1 year in patients.11.EF＜50%of patients with CTO images have shown complete occlusion and paragraph≥15mm occlusion higher than EF≥50%in patients.The differences were statistically significant,P＜0.05.Conclusion1.The proportion of single CTO was more than the proportion of double or three CTO.The proportion of CTO combined three vessel disease was more than the proportion of CTO combined double or single-vessel lesions.In the distribution of CTO vascular,LAD was the first,and then RCA,LCX,other blood vessels.2.CAG showed complicated lesions such as collateral bridge formation,severe calcification,tortuosity and long lesions,et al.Diabetes,hypertension,smoking, cardiac function and duration have some influence on the imaging characteristics of CTO.These clinical and angiogrophic characteristics might make PCI of CTO more difficult and might influence its success rate.3.Most of the patients enrolled in the study presented with the known risk factors of CHD including smoking,hypertension,diabetes and hyperlipidemia.A great proportion of CTO patients had the clinical manifestation of UAP,OMI,heart failure, arrhythmia and stroke.Hypertension,smoking,cardiac function,diabetes and the duration had some impaction on the imaging characteristics of CTO.