Effect Of Percutaneous Coronary Intervention On Cardiac Function Of Patients With Chronic Total Occlusion

Objective: To investigate the effect of percutaneous coronary intervention on cardiac function in patients with chronic total occlusion(CTO).Methods: Between January 2014 and December 2015,119 cases of coronary atery disease(CAD)patients with at least one CTO lesion in Coronary Artery Disease Database of Sichuan Provincial People's Hospital were consecutively enrolled.We compared the left ventricular ejection fraction(LVEF)and left ventricular end diastolic dimension(LVEDD)of patients with underwent successful CTO-PCI and those who failed or not attempted,patients with pathological Q wave underwent successful CTO-PCI and those who failed or not attempted,patients without pathological Q wave underwent successful CTO percutaneous coronary intervention(PCI)and those who failed or not attempted in twelve months.In addition,we compared the LVEF and LVEDD of 106 Single CTO lesion cases underwent successful CTOPCI and those who failed or not attempted in different lesion : left anterior descending(LAD),left circumflex coronary(LCX)and right coronary artery(RCA).Results: The gender,age,TG,LDL-C,CK-MB,BNP,T wave changes,ST depression,history of smoking,myocardial infarction,hypertension,diabetes,family coronary heart disease and preoperative LVEF and LVEDD didn't show any significant difference between the opening of CTO group and non-opening group/ the opening with Q wave group and nonopening with Q wave group / the opening without Q wave group and non-opening without Q wave group(P>0.05).The J-CTO score and Progress-CTO score showed significant differences between the opening of CTO group and non-opening group/ the opening without Q wave group and non-opening without Q wave group(P<0.05)opposite in the opening with Q wave group and non-opening with Q wave group(P>0.05).Comparison of twelve months postoperative data:(1)There were significant differences in cardiac function indexes between CTO opening group and the non-opening group [LVEF(54.90±8.15% vs.51.47±7.39%,P=0.030);LVEDD(50.67±4.31 mm vs.52.5±4.0mm,P=0.025)].The cardiac function indexes of opening group were significantly improved after surgery [ LVEF(54.90±8.15% vs.51.89±9.96%,P=0.001);LVEDD(50.66±4.31 mm vs.52.22±4.34 mm,P=0.001)].While,there were no significant differences in non-opening group [ LVEF(51.95±8.90% vs.51.47±7.39%,P=0.695);LVEDD(51.63±4.52 mm vs.52.55±4.06 mm,P=0.172)].There were no significant differences in Cardiac function indexes between the opening with Q wave group and non-opening with Q wave group[ LVEF(52.17±8.76% vs.50.00±6.83%,P=0.434);LVEDD(53.28±4.50 mm vs.53.38±4.03 mm,P=0.941)].The cardiac function indexes of Q wave opening group were not significantly improved after surgery [LVEF(52.17±8.75% vs.52.41±11.53%,P=0.815);LVEDD(53.28±4.50 mm vs.52.55±5.01 mm,P=0.087)].There were no significant differences in Q wave non-opening group [ LVEF(50.00±6.83% vs.51.00±9.71%,P=0.646);LVEDD(53.38±4.03 mm vs.52.53±3.73 mm,P=0.504)].The Cardiac function indexes in the opening without Q wave group were better than non-opening without Q wave group[ LVEF(56.42±7.44% vs.52.24±7.68%,P=0.025);LVEDD(49.21±3.47 mm vs.52.12±4.09 mm,P=0.002)].The cardiac function indexes of opening without Q wave group were significantly improved after surgery [LVEF(56.42±7.44% vs.51.60±9.07%,P=0.000);LVEDD(49.21±3.47 mm vs.52.04±3.96 mm,P=0.000)].While,there were no significant differences in non-opening without Q wave group[LVEF(52.24±7.68% vs.52.44±8.60%,P=0.893);LVEDD(52.16±4.08 mm vs.51.16±4.88 mm,P=0.239)].The Cardiac function indexes in the opening without Q wave MI group were better than non-opening without Q wave MI group[LVEF(59.89±4.28% vs.50.25±5.73%,P=0.006);LVEDD(56.00±2.94 mm vs.49.66±3.71 mm,P=0.012)].The cardiac function indexes of opening without Q wave MI group were significantly improved after surgery [LVEF(59.89±4.28% vs.48.33±10.05%,P=0.004);LVEDD(49.66±3.71 mm vs.53.00±5.72 mm,P=0.021)].While,there were no significant differences in non-opening without Q wave MI group [LVEF(50.25±5.73% vs.49.75±11.89%,P=0.863);LVEDD(56.00±2.94 mm vs.54.75±5.73 mm,P=0.059].The Cardiac function indexes in the opening without MI group were better than non-opening without MI group [ LVEF(58.66±6.37% vs.51.01±5.72%,P=0.013);LVEDD(49.15±3.42 mm vs.51.86±4.41 mm,P=0.008)].The cardiac function indexes of opening without MI group were significantly improved after surgery [ LVEF(58.66±6.37% vs.52.73±9.22%,P=0.013); LVEDD(49.15±3.42 mm vs.51.75±3.55 mm,P=0.011)].While,there were no significant differences in non-opening without MI group [ LVEF(51.01±5.72% vs.53.55±8.40%,P=0.084);LVEDD(51.86±4.41 mm vs.50.59±4.47 mm,P=0.075].(2)There were significant differences in cardiac function indexes between LAD-CTO opening group and the non-opening group [LVEF(56.06±7.73% vs.49.09±5.66%,P=0.009);LVEDD(48.18±4.46 mm vs.52.15±3.93 mm,P=0.001)].The cardiac function indexes of LAD-CTO opening group were significantly improved after surgery [ LVEF(56.06±7.73% vs.48.69±7.74%,P=0.000);LVEDD(48.18±4.46 mm vs.51.45±4.29 mm,P=0.042)].While,there were no significant differences in LAD-CTO non-opening group [ LVEF(49.09±5.66% vs.51.54±6.18%,P=0.063);LVEDD(52.15±3.93 mm vs.50.36±3.72 mm,P=0.053].There were no significant differences in cardiac function indexes between LCX-CTO opening group and the non-opening group [ LVEF(53.58±10.67% vs.57.50±6.50%,P=0.324);LVEDD(50.67±3.89 mm vs.52.80±3.39 mm,P=0.190)].The cardiac function indexes of LCX-CTO opening group were not significantly improved after surgery [LVEF(53.58±10.67% vs.55.00±9.43%,P=0.082);LVEDD(50.67±3.89 mm vs.51.33±3.23 mm,P=0.649)].There were no significant differences in LCX-CTO non-opening group [ LVEF(57.50±6.50% vs.56.50±9.44%,P=0.845);LVEDD(52.80±3.39 mm vs.51.50±4.83 mm,P=0.816].There were significant differences in cardiac function indexes between RCA-CTO opening group and the non-opening group [ LVEF(54.27±7.67% vs.49.47±7.17%,P=0.035);LVEDD(49.41±4.37 mm vs.54.05±4.52 mm,P=0.027)].The cardiac function indexes of RCA-CTO opening group were significantly improved after surgery [LVEF(54.27±7.67% vs.50.11±10.57%,P=0.039);LVEDD(49.41±4.37 mm vs.52.58±4.86 mm,P=0.048)].While,there were no significant differences in RCA-CTO non-opening group [ LVEF(49.47±7.17% vs.48.35±8.26%,P=0.792);LVEDD(54.05±4.52 mm vs.53.18±4.40 mm,P=0.907].Conclusion: 1.Successful CTO-PCI could significantly improve cardiac function of patients who suffered from CTO lesions without pathologic Q-wave.Howere,successful CTO-PCI couldn't significantly improve cardiac function of patients who suffered from CTO lesions with pathologic Q-wave.2.Successful CTO-PCI could significantly improve cardiac function of patients who suffered from CTO lesions of LAD and LCX.Howere,successful CTO-PCI couldn't significantly improve cardiac function of patients who suffer from CTO lesions of RCA.