Fang Hsiu-Yu, Wu Chiung-Jen, Fang Chih-Yuan, Lee Wei-Chieh
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Cardiovasc Revasc Med. 2017 Sep;18(6):411-417. doi: 10.1016/j.carrev.2017.03.018. Epub 2017 Mar 22.
Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI).
Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI.
The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF) <40% predicted three-year cardiac death.
There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF <40% were the predictors for three-year cardiac death.
关于右冠状动脉（RCA）慢性完全闭塞（CTO）再通后的临床结局，可用数据有限。本研究旨在评估成功进行RCA CTO经皮冠状动脉介入治疗（PCI）后远端分支前向血流的临床结局。
纳入2002年1月至2012年12月期间接受RCA CTO PCI的538例患者。将心肌梗死（MI）、靶血管血运重建、心源性死亡、主要不良心脏事件和全因死亡率等临床结局与成功进行RCA CTO PCI后远端分支的前向血流进行比较。
CTO位于近端节段的占57.6%，中段节段的占27.5%，远端节段的占14.9%。平均Syntax评分是18.4±9.6，47.8%的患者Syntax评分大于27.5。共有62.8%的患者远端分支最终达到心肌梗死溶栓（TIMI）-3级血流，16.9%的患者仅一个主要分支最终达到TIMI-3级血流，11.3%的患者为TIMI-1-2级血流，8.9%的患者无前向血流。双侧分支均保留时围手术期MI的发生率较低（13.9%对23.0%和18.8%，p=0.01）。远端侧支前向血流良好和不佳的组之间临床结局相似。终末期肾病（ESRD）和左心室射血分数（LVEF）<40%是三年心源性死亡的预测因素。
RCA远端侧支成功再通时临床结局无显著差异。ESRD和LVEF<40%是三年心源性死亡的预测因素。
