Medium And Long-term Prognosis Of Chronic Total Occulusion Lesions In Different Branches Of Coronary Artery After PCI Revascularization And The Affecting Factors

Objective: To explore the risk factors of chronic total occulus(CTO)in patients with coronary artery disease and compare the mid-and long-term prognosis and analyze the influencing factors of chronic total occlusion(CTO)in different branches of coronary artery after percutaneous coronary intervention(PCI)revascularization.Methods: Patients with coronary artery disease confirmed by selective coronary angiography were divided into non-CTO group and CTO group according to the angiographic results.The clinical data of the two groups were compared.CTO-related variables(P<0.1)were obtained by single factor screening,and multivariate regression were conducted to analyze and explore the risk factors for the onset of CTO.A total of 122 patients with CTO were divided into different branches of lesions according to the left anterior descending branch(LAD),the left circumflex branch(LCX),and the right coronary artery(RCA).81 of them were tried to implement PCI,and Kaplan-Meier survival analysis was used to compare the prognoses(survival rate,major adverse cardiac events,left ventricular function)between the successful PCI group and non-revascularization(including unsuccessful PCI and non-PCI)group.The same method were used in different branches CTO after successful PCI,successful PCI and non-revascularization in each different branch groups.Univariate analysis was used to screen for factors associated with major clinical adverse events(P < 0.1),and then the meaningful factors were adopted to the COX risk regression model to analyze risk factors affecting clinical outcomes.The endpoint events we observed include survival rate,major adverse cardiac events(MACE),and left ventricular function.Results: A total of 244 patients were enrolled,including 120 in the non-CTO group and 122 in the CTO group.Univariate analysis showed that the white blood cell count(6.3 ± 2.2 VS 7.4 ± 2.9,P= 0.002),fibrinogen(2.88±0.83 VS 3.17±1.00,P=0.014),low-density lipoprotein(3.83±1.12 VS 4.57±1.43,P=0.026),and blood uric acid(335.1±99.2 VS 368.4±112.8,P=0.016)were significantly higher in the CTO group than in the control group;the proportion of males [103(84.4)VS 87(72.5),P= 0.024],smoking history [54(44.3)VS 37(30.8),P= 0.031],diabetes history [46(37.7)VS 26(21.7),P=0.047],high-sugar diet[51(41.8)VS23(19.2),P=0.014]were also significantly higher in the CTO group;multivariate logistic regression analysis showed that white blood cell counts(OR=1.193,95% CI: 1.064-1.338,P=0.002)and blood uric acid levels(OR=3.358,95)% CI: 0.975-1.095,P=0.047)are independent risk factors for CTO.Among the 113 CTO patients who underwent PCI,81 cases were successfully revascularized.The cumulative event-free survival rate in the successful PCI revascularization group was significantly higher than that in the non-revascularization group(70.4% vs.58.5%,P=0.042)during the mean follow-up of 27 months(26.7 ±20.7),and the total incidence of adverse events was significantly lower than that in the non-revascularization group(24.7% vs.56.1%,P=0.027).In RCA group,LAD group and two or more CTO lesions group,the incidence of recurrent angina pectoris,heart failure,MACE and all-cause death in those successfully treated with revascularization were significantly lower than that of non-revascularization group,the P value of these groups was 0.002,0.017,0.013,respectively.There was no significant difference in LCX group(P=0.408).The total increased left ventricular EF(?EF1=3.1±1.4)after successful PCI in all patients with CTO was significantly higher than that in the non-revascularization group(?EF2=0.3±1.2),P=0.038.The ?EF after successful revascularization in the RCA group and LAD group were 3.6±1.7(%)?4.1±1.8%(P value =0.045?0.038),the ?LAD were 0.5±0.3mm?0.5±0.6mm(P value =0.315?0.236),?LVEDD were 0.5±0.4mm?0.5±0.3mm(P value=0.287?0.381),?LVESD were 0.6±0.3mm?0.9±1.0mm(P value =0.348?0.341),?RAD were-0.2 ± 0.5mm ?-0.1 ± 0.5mm(P value =0.126 ? 0.256),respectively,which has significance compared with the same group of patients without revascularization.There was no significant difference about ?EF(P value = 0.115,0.475)??LAD(P value = 0.315?0.236),?LVEDD(P value = 0.287?0.381),?LVESD(P value =0.348?0.341),?RAD(P value = 0.126?0.256)in LCX group [0.6±0.3(%)] and two or more branches group [0.8 ± 0.3(%)] after successful PCI revascularization.Cox proportional risk regression analysis showed that the prognostic factors of CTO patients after PCI revascularization included diabetes history(95% CI:1.253-8.449,P=0.015),J-CTO grade(95% CI:1.135-5.325,P=0.012),serum total bilirubin(95%CI:0.874-0.996,P=0.038)and serum uric acid levels(95% CI:1.001-1.007,P=0.006),among of which diabetes history?RR value were 3.254?2.875 respectively?.Conclusions: The counts of white blood cells and blood uric acid level are independent risk factors for CTO.Successful PCI revascularization of coronary CTO lesions can improve the overall cumulative event-free survival rate in the middle and long term.However,there are differences in the incidence of recurrent angina pectoris,heart failure,MACE,all-cause death and the improvement of left ventricular EF in different branches of CTO lesions.Diabetes history and hihger J-CTO scores increases the risk of mid-and long-term death in CTO patients.