| BackgroundChronic Total Occlusion(CTO)refers to the complete occlusion of coronary arteries and the occlusion more than 3 months.It is the most technically difficult and high-risk type of coronary artery disease(CAD)through Percutaneous coronary Intervention(PCI),accounting for 33%?50%of patients with coronary heart disease.Although with the development of PCI technology,the success rate of PCI in opening occluded blood vessels in CTO patients is close to 90%,and more and more evidence suggests that PCI may be helpful in improving symptoms,heart function,and long-term survival benefits of CTO patients.However,limited to technology,risk,and medical expenses,only 9-10%of CTO patients in China choose PCI treatment at present,so there are still many problems to be further studied in PCI treatment of CTO,among which risk prediction and control is a hot issue.Multiple studies have shown that chronic renal failure(CRF)is one of the independent predictors of early and late survival in CAD patients,but currently there is little analysis on the related factors affecting the long-term prognosis of patients with CRF and CTO treated with PCI,which needs further study and discussion.Objectives(1)To analyze the difference in the long-term prognosis of patients with CTO lesions with CRF treated by PCI compared with conservative drug treatment alone.(2)To analyze the effects of CRF of different severity on the long-term prognosis of patients with CTO after PCI treatment.(3)To analyze the clinical and physicochemical factors affecting the long-term prognosis of patients with CRF and CTO by PCI,better predict the long-term risk of patients after PCI,reduce the probability of postoperative complications of CTO disease,and improve the prognosis of CTO patients to provide effective guidance.MethodsA retrospective analysis of coronary angiography was performed in the department of cardiology,Shenzhen hospital of Peking University from October 2014 to October 2018.The angiography results indicated that there was at least one CTO lesion in the main branch of coronary artery,and 105 CAD patients were successfully opened occluded diseased blood vessels after PCI.170 CTO patients with mild,moderate,or severe renal insufficiency treated conservatively were taken as the control group.The Estimated glomerular filtration rate(eGFR)was calculated according to preoperative Creatinine(Cre)values.The group with eGFR?90mL/min/1.73m~2 was the normal renal function group(A group,n=47);the group with 60<eGFR?89mL/min/1.73m~2 was the mild renal insufficiency group(B group,n=31);the group with 15<eGFR?59 mL/min/1.73m~2 was the moderate and severe renal insufficiency group(C group,n=27).All of them were treated with PCI.The differences among the four groups of patients in various clinical baseline levels,laboratory examination indicators,coronary angiography results,treatment results during PCI,and end-point events of 1-year follow-up were compared.The end event was defined as the occurrence of postoperative all-cause death or major adverse cardiac and cerebral events(MACCE).COX risk ratio model was used to analyze the independent risk factors for end-point events in CTO patients with renal insufficiency after PCI.The survival curve of Kaplan-Merier was used to analyze the survival curve of CTO patients with different renal insufficiency after PCI.Results?.The comparison of baseline materials found that the heart rate of patients in group C was the highest,and the differences in heart rate of patients in the control group,group A,group B,and group C were statistically significant(P<0.01);patients in group C had the highest systolic blood pressure,and the difference of systolic blood pressure in the control group,group A,group B,and group C was statistically significant(P<0.01);there was no statistically significant difference between the control group,group A,group B,and group C in NYHA classification(P>0.05);the proportion of the control group,group A,group B,and group C were 30.59%,25.53%,29.03%,and 37.04%respectively in CCS classification for III level,the differences between the groups with statistical significance(P<0.05);the level of left ventricular ejection fraction(LVEF%)was the lowest in group C,and the differences between the control group,group A,group B,and group C were statistically significant(P<0.05);there was no statistically significant difference in the number and location of CTO target vascular lesions and the number and length of stents used in PCI between groups A,B and C(P>0.05).?.The proportion of Cre,LVEF%,NHYA III+IV level,and CCS III+IV level was compared in different groups before and after treatment.The results showed that the NHYA III+IV level of group A,group B,and group C after treatment was significantly lower than that before treatment(P<0.05);the proportion of CCS III+IV level in group A and group B after treatment was significantly lower than that before the treatment,and the difference was statistically significant(P<0.05);the Cre level of patients in the control group,group B,and group C after treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).?.In the control group,there were 38(22.35%)deaths,35(20.59%)cases of non-fatal myocardial infarction,21(12.35%)cases of stroke,59(34.71%)cases of heart failure,19 cases of re-revascularization(11.18%),and 69(40.59%)cases of re-hospitalizations during follow-up.In group A,B,and C,there were 9(8.57%)deaths,11(10.48%)cases of non-fatal myocardial infarction,3(2.86%)cases of stroke,16(15.24%)cases of heart failure,6(5.71%)cases of re-revascularization,and 28(26.67%)cases of re-hospitalization.In addition,there were significant differences in the probability of all-cause death,non-fatal myocardial infarction,stroke,heart failure,re-revascularization,and re-hospitalization among patients in the control group,group A,group B and group C(P<0.05).Kaplan-Meier survival curves of each endpoint event were plotted and compared by means of log-rank test.Except that there was no statistically significant difference between Kaplan-Meier survival curves of group A and group B with stroke(P>0.05),there were statistically significant differences between Kaplan-Meier survival curves of other groups with different endpoint events(P<0.05).?.COX model was used to analyze the risk ratio.It was found that after correction,the all-cause death risk ratio of the control group,group B and group C were 3.667,2.134and 3.524,respectively,and the difference was statistically significant compared to group A(P<0.05);after correction,the MACCE risk ratios of the control group,group B and group C were 2.489,1.882,and 3.097,respectively,and the differences were statistically significant compared to group A(P<0.05).Moreover,eGFR level<90 mL/min/1.73m~2,age>70 years,3-vessel lesion,HGB<100g/L,preoperative LVEF<50%,Cre>100?mol/L,NT-pro BNP>350 pg/m were independent risk factors for all-cause death(P<0.05),while eGFR level lower than 90 mL/min/1.73m~2,age>70,diabetes history,3-vessel lesions,HGB level<100g/L,preoperative LVEF<50%,Cre>100?mol/L were independent risk factors for MACCE in patients(P<0.05).Conclusion?.CTO patients with renal insufficiency who were successfully treated with PCI had better long-term prognosis than patients with renal insufficiency who were treated conservatively.?.Renal insufficiency is an independent risk factor affecting the long-term prognosis of CTO patients undergoing PCI.Moreover,the more severe renal insufficiency is,the higher the risk of MACCE endpoint events such as all-cause death,non-fatal myocardial infarction,stroke,heart failure,and re-revascularization will be after PCI.?.e GFR<90 mL/min/1.73m~2,advanced age,presence of multi-vessel coronary artery disease,anemia,and heart failure are independent predictive risk factors for the long-term prognosis of renal insufficiency patients with CTO treated with PCI. |
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