| BackgroundWith the development of Chinese economy,the national living standard has been widely improved,and the life style has changed profoundly.The prevalence of cardiovascular disease risk factors is becoming more and more obvious,and the burden of heart disease is increasing,especially in the process of accelerating urbanization and aging trend.Coronary heart disease(CHD)is one of the most common types among heart disease,which makes national health suffer a great threat.CHD is a kind of heart disease characterized by myocardial ischemia,hypoxia,or necrosis,which caused by stenosis or occlusion of the lumen because of coronary atherosclerosis or(and)coronary artery spasm.With the rapid development of percutaneous coronary intervention(PCI),new interventional equipment and technology constantly emerging,PCI has become an important treatment of CHD.Chronic total occlusion(CTO)is a special type of CHD.There are two common causes of CTO lesions.One is rupture of atherosclerotic plaque on the basis of mild to moderate stenosis,leading to acute thrombosis.With time elapsing,the plaques rich in cholesterol lipids are gradually replaced by collagen.The organizing thrombus structure is mixed with fibrotic structure,and some lesions appear calcified and gradually evolve into a fibrous calcific occlusion structure mixed with loose and dense connective tissue.Another is a completely occluded lesion formed by the progressive enlargement of highly stenotic lesions.Most patients with CTO have clinical symptoms such as myocardial ischemia and angina,which gradually appears myocardial remodeling with the progression of the course.Eventually it develops into heart failure,which seriously affects the quality of life and prognosis of patients.At present,CTO is considered as one of the most complex lesions in PCI treatment.ObjectiveThe purpose of this study was to investigate the effect of percutaneous coronary intervention on left ventricular function and prognosis in patients with single vessel chronic total occlusion.MethodsA total of 219 patients admitted to the department of cardiology of the first affiliated hospital of zhengzhou university from August 2016 to August 2017 were selected,whose course was more than 3 months.All patients were diagnosed with total occlusion of the main coronary artery which is greater than or equal to 2.5mm in diameter by coronary angiography(CAG)(The lumen stenosis was 100% and the TIMI blood flow was 0).Among them,113 patients were successfully treated with PCI and included in the PCI group.106 patients were treated with optimal medical therapy(OMT)and included in the OMT group.Collect baseline data before enrollment and review follow-up data at 6 and 12 months after discharge.The changes of left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVED),left ventricular fractional shortening(LVFS)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)at 6 months and 12 months were analyzed.Meanwhile,the major adverse cardiovascular events(MACE)of all the patients at 6 months and 12 months were counted.Results1.There were no statistical difference in baseline data of two groups: age,gender,BMI,history of hypertension,diabetes,past medical history of myocardial infarction,past medical history of PCI and CABG,family history of coronary heart disease,smoking history,history of peripheral artery occlusion,the number of lesion vessels,basic medication,serological indexes,ultrasonic cardiogram indexes,characteristics of CTO(p>0.05).2.6 months after discharge,indexes compared with baseline data in PCI group: NT-proBNP level decreased[547.9(407.4-669.0)vs 626.8(462.3-833.0)],LVEF increased[(53.05±4.24)vs(50.26±5.75)],LVFS increased[(33.07±2.87)vs(31.72±3.71)] and the differences were statistically significant(p<0.05).The level of NT-proBNP in OMT group decreased compared with baseline data[540.6(441.0-662.6)vs 593.8(430.7-787.6)],and the difference was statistically significant(p<0.05).3.12 months after discharge,indexes compared with baseline data in PCI group: NT-proBNP level decreased[398.2(355.8-452.2)vs 626.8(462.3-833.0)],LVEF increased[(56.41±5.70)vs(50.26±5.75)],LVFS increased[(34.74±4.00)vs(31.72±3.71)],LVED decreased[(50.08±5.14)vs(53.40±6.06)],and the differences were statistically significant(p<0.05);indexes compared with baseline data in OMT group: NT-proBNP level decreased[515.8(429.7-615.2)vs 593.8(430.7-787.6)],LVEF increased[(53.74±3.18)vs(51.73±7.25)],LVFS increased[(33.26±4.19)vs(30.90±4.60)],LVED decreased[(51.18±5.55)vs(54.42±7.87)],and the differences were statistically significant(p<0.05).4.12 months after discharge,NT-proBNP level in PCI group was lower than that in OMT group[398.2(355.8-452.2)vs 515.8(429.7-615.2)],the difference was statistically significant(p<0.05);LVEF in PCI group was higher than that in OMT group[(56.41±5.70)vs(53.74±3.18)],the difference was statistically significant(p<0.05);LVFS in PCI group was higher than that in OMT group[(34.74±4.00)vs(33.26±4.19)],the difference was statistically significant(p<0.05).5.6 months after discharge,MACE rate in PCI group was lower than that in OMT group[(4,3.54%)vs(11,10.38%)],the difference was statistically significant(p=0.045);12 months after discharge,MACE rate in PCI group was significantly lower than that in OMT group[(9,7.96%)vs(21,19.81%)],the difference was statistically significant(p=0.011);recurrence of angina pectoris in PCI group was significantly lower than that in OMT group[(8,7.08%)vs(17,16.04%)],the difference was statistically significant(p=0.037).Conclusion1.Single vessel CTO treated with PCI can improve the cardiac function of patients.2.PCI therapy is more effective than oral medication in patients with single vessel chronic total occlusion.3.Single vessel CTO treated with PCI can significantly reduce the recurrent angina pectoris of patients in 1 year. |
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