Clinical Value Of Interventional Therapy In Different Coronary Artery CTO Lesions

Objective: Chronic total occlusion of the coronary arteries is the terminal stage of coronary atherosclerosis.The incidence of major cardiac adverse events in patients with CTO is significantly higher than that in patients with coronary heart disease,which seriously affects the quality of life of patients.Percutaneous coronary intervention is the main treatment for CTO lesions.CTO-PCI is considered to be the biggest obstacle and challenge in the current cardiovascular PCI field.Its technical difficulty is relatively large,the success rate of surgery is relatively low,and the incidence of intraoperative and postoperative complications is high.In recent years,with the development of CTO special equipment and equipment and the continuous advancement of PCI technology,the success rate of CTO lesion interventional therapy is constantly improving,and the patient's prognosis quality of life is also improving.At present,there are few and controversial studies on the benefit of different interventional treatments for different coronary artery CTO lesions.This study retrospectively analyzed the differences in survival benefit between different target vessel vascular CTO lesions with and without prognosis,and further analyzed the main risk factors associated with prognosis of cardiogenic death in patients with CTO.It provides an objective clinical basis for the rational selection of treatment and clinical prognosis in patients with CTO in different target vessels.Methods: Between January 2015 and December 2017,377 patients with single CTO who underwent concurrent coronary angiography in the Department of Cardiology of our Hospital and met the exclusion criteria were enrolled.Collect and completely recordthe patient's general clinical information,laboratory blood biochemistry,major cardiac ultrasound results,and interventional procedures.All CTO patients were followed for at least 12 months.The main content of the follow-up was the major adverse cardiovascular events(MACEs)that occurred during the follow-up period(including cardiac death,nonfatal MI,angina or heart failure).Increased re-hospitalization.According to the results of coronary angiography and the opening of target vessels,CTO patients were divided into target vascular intervention successful open group and unopened group.(including patients who only underwent conservative drug therapy and failed PCI),and further based on CTO target vessels.Left anterior descending LAD open and unopened groups,left circumflex artery LCX open and unopened groups,right coronary artery RCA open and unopened groups The differences in the main adverse cardiovascular events between the two groups were compared.Kaplan-Meier survival analysis and log-rank test were used to compare the survival curves to compare the differences in cardiac death between patients with different coronary CTOs.At the same time,the Cox proportional hazard regression model was used to analyze the risk of cardiac death in CTO patients.The risk factors of single-factor analysis were analyzed by Cox multivariate analysis to evaluate the prognosis of cardiogenic death in patients with CTO.Independent risk factors.Results: 1.Among the 377 patients with single CTO,260(69%)were male and 117(31%)were female.LAD-CTO 152 cases(40%),LCX-CTO 62 cases(17%),RCA-CTO 163 cases(43%),three groups of baseline comparison NT-pro BNP in LAD-CTO group compared with RCA-CTO and LCX-The CTO group is high,and the proportion of male patients in each group is the majority.2.There were 280 patients in the CTO group and 97 patients in the unopened group.Among them,there were 121 cases in the LAD-CTO open group and 31 cases in the unopened group;47 cases in the LCX-CTO open group and 15 cases in the unopened group;112 cases in the RCA-CTO open group and 51 cases in the unopened group.A total of 88 patients(23.3%)had MACEs in all CTO patients,including 14 patients(3.7%)with central death,71 patients(18.8%)with angina or heart failure,and 3patients with nonfatal myocardial infarction(0.8%).A total of 47 cases(16.8%)of MACEs occurred in all single CTO open groups,and 41 cases(42.3%)of MACEs occurred in the unopened group.The incidence of MACEs in the unopened group was significantly increased.3.In the single CTO population,the overall MACEs event was significantly lower in the PCI-opening group than in the unopened group,with statistically significant differences(16.8% vs 42.3%,P < 0.001).The total MACEs event in the LAD-CTOopening group was significantly lower than that in the unopened group(20.7% vs 51.6%,P =0.001).There was no significant difference in the total MACEs between the LCX-CTO open and the unopened group(17%vs20%,P =1);the total MACEs event in the RCA-CTO open group was significantly lower than that in the unopened group(12.5% vs 43.1%,P < 0.001).4.Using Kaplan-Meier survival analysis and log-rank test,there was a significant difference between the single CTO open group and the unopened group curve(P =0.003,log-rank test),P <0.05,open group and not There was a significant difference in cardiac death between the prognosis group and the open group.In the control group of different target vessels,there was a significant difference in the prognosis of cardiac death between the LAD-opened group and the unopened group(P =0.049).There was no significant difference in the occurrence of prognosis of cardiac death between the LCX open group and the unopened group(P =0.999).There was a significant difference in the prognosis of cardiogenic death between the RCA-opening group and the unopened group(P =0.017).5.Cox multivariate regression analysis showed that age,chronic kidney disease,LVEF,NT-pro BNP,and target vessel not open were independent risk factors for cardiogenic death in patients with CTO.Conclusion: 1.Targeted vascular accession in a single CTO lesion is significantly lower than that in the prognosis of total MACEs and cardiac death.The prognosis of CTO in different target vessels is different.The opening of the target vessels LAD and RCA can significantly reduce the incidence of total MACEs events and cardiac death,but no obvious benefit after LCX-CTO intervention.Conclusions help to optimize treatment options for different coronary CTO lesions.2.Age,chronic kidney disease,LVEF,NT-pro BNP and target vessel not open are independent risk factors for prognosis of cardiogenic death in CTO patients.