| ObjectiveTo investigate the effectiveness and prognosis of percutaneous coronary intervention（PCI）in patients with Chronic Total Occlusion（CTO）MethodsPatients diagnosed with coronary atherosclerotic heart disease（CAD）and confirmed by coronary angiography（CAG）to have at least one CTO were collected from the Department of Cardiovascular Medicine,First People’s Hospital of Yunnan Province from May 2019 to April2021.The number of patients with CTO was 268.The 142 patients with successful CTO-PCI were included in the PCI group;the 126 patients with failed PCI and no coronary intervention were treated with optimal medical therapy（OMT）and included in the OMT group;217patients in the single CTO group and 51 patients in the multiple CTO group were divided according to the number of CTO lesions.Among the patients in the single CTO group,121 patients with successful PCI were included in the PCI group,96 patients with failed opening and no coronary intervention were included in the OMT group,21 patients in the multi-CTO group with successful CTO-PCI were included in the PCI group,30 patients with failed opening and no coronary intervention were included in the OMT group.Basic data and follow-up and review data at 3,6 and 12 months after discharge were collected from all patients.Cardiac function parameters including left ventricular ejection fraction（LVEF）,left ventricular shortening（LVFS）,and left ventricular diastolic shortening（LVSD）were analysed at 3,6 and 12 months after discharge.The changes in left ventricular end diastolic diameter（LVED）were also assessed by the SF-36 quality of life scale at 3,6 and 12 months after discharge.Major adverse cardiovascular events（MACE）were also recorded for all patients at3,6 and 12 months after discharge.Results1.Baseline data: age,gender,history of hypertension,history of diabetes mellitus,history of hyperlipidemia,history of smoking,history of previous heart attack,history of previous stroke,total cholesterol,triglycerides,HDL,LDL,creatinine,N-terminal brain natriuretic peptide precursors,LVEF,LVFS,LVED,baseline medication,number of concurrently treated non-CTO lesions,CTO lesion characteristics,etc.There were no statistically significant differences in clinical information（P>0.05）;among them,the difference in the proportion of left gyral branches was statistically significant in the PCI and OMT groups（P<0.05）.2.Three months after discharge,LVEF and LVFS values increased in the PCI group compared to baseline values,with statistically significant differences（P<0.05）,and LVED decreased compared to baseline values,with no statistically significant differences（P>0.05）;LVEF,LVFS and LVED decreased in the OMT group compared to baseline values,with no statistically significant differences（P>0.05）).In the single CTO PCI group,LVEF and LVFS increased compared to baseline values,with statistically significant differences（P<0.05）,and LVED decreased compared to baseline values,with no statistically significant differences（P>0.05）;in the single CTO OMT group,LVEF increased compared to baseline values,with no statistically significant differences（P>0.05）,and LVFS decreased compared to baseline values,with no statistically significant differences（P>0.05）.The difference was not statistically significant（P>0.05）and the difference was not statistically significant（P>0.05）.In the multi-CTO PCI group,LVEF and LVFS increased compared to baseline values,all differences were statistically significant（P<0.05）,LVED increased compared to baseline values,the differences were not statistically significant（P>0.05）;in the multi-CTO OMT group,LVEF and LVFS decreased compared to baseline values,the differences were not statistically significant（P>0.05）,LVED increased compared to baseline values,the differences were not statistically significant（P>0.05）,LVED increased compared to baseline values,the differences were not statistically significant（P>0.05）.LVED increased compared to the baseline value,the difference was not statistically significant（P>0.05）.3.Six months after discharge,LVEF and LVFS increased in the PCI group compared to baseline values,with statistically significant differences（P<0.05）,and LVED decreased compared to baseline values,with no statistically significant differences（P>0.05）;LVEF,LVFS and LVED increased in the OMT group compared to baseline values,with no statistically significant differences（P>0.05）..In the single CTO PCI group,LVEF and LVFS increased compared to baseline values,all differences were statistically significant（P<0.05）,and LVED decreased compared to baseline values,the differences were not statistically significant（P>0.05）;in the single CTO OMT group,LVEF,LVFS and LVED increased compared to baseline values,the differences were not statistically significant（P> 0.05）.In the multiple CTO PCI group,LVEF and LVFS increased compared to baseline values,all differences were statistically significant（P<0.05）and LVED decreased compared to baseline values,the differences were not statistically significant（P>0.05）;in the multiple CTO OMT group,LVEF,LVFS and LVED increased compared to baseline values,the differences were not statistically significant（P> 0.05）.4.Twelve months after discharge,LVEF and LVFS increased in the PCI group compared to baseline values,with statistically significant differences（P<0.05）,and LVED decreased compared to baseline values,with statistically significant differences（P<0.05）;LVEF and LVFS increased in the OMT group compared to baseline values,with no statistically significant differences（P>0.05）,and LVED The difference was not statistically significant（P>0.05）.In the single CTO PCI group,LVEF and LVFS increased compared to baseline values,with statistically significant differences（P<0.05）,and LVED decreased compared to baseline values,with statistically significant differences（P<0.05）;in the single CTO OMT group,LVEF,LVFS and LVED increased compared to baseline values,with no statistically significant differences（P> 0.05）.In the multi-CTO PCI group,LVEF and LVFS increased from baseline values,with a statistically significant difference（P<0.05）,and LVED decreased from baseline values,with a statistically significant difference（P<0.05）;in the multi-CTO OMT group,LVEF and LVFS increased from baseline values,with no statistically significant difference（P>0.05）,and LVED decreased from baseline values.LVED decreased from baseline values,with no statistically significant difference（P>0.05）.5.Three months after discharge,LVEF and LVFS were higher in the PCI group than in the OMT group,with a statistically significant difference（P<0.05）,and LVED was lower than in the OMT group,with no statistically significant difference（P>0.05）;LVEF and LVFS were higher in the single-branch CTO PCI group than in the OMT group,with a statistically significant difference（P<0.05）,and LVED At 6 months,LVEF and LVFS were higher in the PCI group than in the OMT group,and the difference was statistically significant（P>0.05）.The difference was statistically significant（P<0.05）,and LVED was lower than that of the OMT group,and the difference was statistically significant（P<0.05）;LVEF and LVFS were higher in the single CTO PCI group than in the OMT group,and the difference was statistically significant（P<0.05）,and LVED was lower than that of the OMT group,and the difference was statistically significant（P<0.05）;multiple At 12 months,LVEF and LVFS were higher in the PCI group than in the OMT group,with a statistically significant difference（P<0.05）,and LVED was lower than in the OMT group,with a statistically significant difference（P<0.05）.OMT group,with a statistically significant difference（P<0.05）;LVEF and LVFS were higher in the single CTO PCI group than in the OMT group,with a statistically significant difference（P<0.05）,and LVED was lower than in the OMT group,with a statistically significant difference（P<0.05）;LVEF and LVFS were higher in the multiple CTO PCI group than in the OMT group,with a statistically The difference was statistically significant（P<0.05）,and the LVED was lower than that of the OMT group,with a statistically significant difference（P<0.05）.6.From March to December after discharge,all SF-36 quality of life scores were significantly higher in the PCI group than in the OMT group,with a statistically significant difference（P<0.05）;all SF-36 quality of life scores were significantly higher in the single CTO PCI group than in the OMT group,with a statistically significant difference（P<0.05）;all SF-36 quality of life scores were significantly higher in the multiple CTO PCI group than in the The difference was statistically significant（P<0.05）.7.7.During the 12-month follow-up period,total MACE events occurred in the PCI group than in the OMT group,and the difference was statistically significant（P<0.05）;total MACE events occurred in the single-branch CTO PCI group than in the OMT group,and the difference was statistically significant（P<0.05）;total MACE events occurred in the multi-branch CTO PCI group than in the OMT group,but the difference was not statistically significant（P> 0.05）.Conclusion1.successful CTO-PCI improves patient cardiac function and quality of life,with more pronounced improvements in cardiac function with multiple CTOs.2.Successful CTO-PCI reduces the incidence of MACE,decreases the number of angina attacks and reduces readmission rates,and improves clinical prognosis. |
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