CAJ | 학술논문

目的：评价对冠心病引起的严重心力衰竭冠状动脉三支血管病变仅单支开放的患者行经皮冠状动脉介入治疗（PCI）的安全性和有效性。方法2004年9月至2013年12月因冠心病引起的严重心力衰竭入院并接受PCI的患者中，27例患者冠状动脉造影显示三支血管严重病变，其中两支血管呈慢性完全闭塞病变（CTO），单支开放的冠状动脉存在严重狭窄、但无明显钙化弯曲。对27例冠状动脉严重狭窄仅单支开放的患者行PCI，观察PCI造影和临床成功率，院内临床症状、术前及术后1周血浆脑钠肽（BNP）、左心室射血分数（LVEF）变化及30 d主要不良心脏事件（MACE，包括死亡、心肌梗死、靶血管再次血运重建）发生率。结果 PCI即刻造影及临床成功率均为27例（100%）。术后胸闷气短症状改善为27例（100%），NYHA心功能分级由Ⅳ级提高到Ⅲ级有22例（81.5%）。术前与术后1周血浆BNP[（2699.6±1104.7）pg/ml比（737.0±261.7）pg/ml，P＜0.05]、LVEF[（26.89±5.70）%比（36±3.41）%，P＜0.05]比较，差异有统计学意义。术后发生对比剂肾病1例（3.7%），经床旁血液透析48 h后肾功能恢复。院内及30 d随访，未发生MACE。结论冠心病引起的严重心力衰竭冠状动脉三支血管病变患者，在两支血管CTO未开通情况下，对严重狭窄但无明显钙化弯曲的单支开放冠状动脉病变行PCI成功率高，短期观察安全有效。
목적：평개대관심병인기적엄중심력쇠갈관상동맥삼지혈관병변부단지개방적환자행경피관상동맥개입치료（PCI）적안전성화유효성。방법2004년9월지2013년12월인관심병인기적엄중심력쇠갈입원병접수PCI적환자중，27례환자관상동맥조영현시삼지혈관엄중병변，기중량지혈관정만성완전폐새병변（CTO），단지개방적관상동맥존재엄중협착、단무명현개화만곡。대27례관상동맥엄중협착부단지개방적환자행PCI，관찰PCI조영화림상성공솔，원내림상증상、술전급술후1주혈장뇌납태（BNP）、좌심실사혈분수（LVEF）변화급30 d주요불양심장사건（MACE，포괄사망、심기경사、파혈관재차혈운중건）발생솔。결과 PCI즉각조영급림상성공솔균위27례（100%）。술후흉민기단증상개선위27례（100%），NYHA심공능분급유Ⅳ급제고도Ⅲ급유22례（81.5%）。술전여술후1주혈장BNP[（2699.6±1104.7）pg/ml비（737.0±261.7）pg/ml，P＜0.05]、LVEF[（26.89±5.70）%비（36±3.41）%，P＜0.05]비교，차이유통계학의의。술후발생대비제신병1례（3.7%），경상방혈액투석48 h후신공능회복。원내급30 d수방，미발생MACE。결론관심병인기적엄중심력쇠갈관상동맥삼지혈관병변환자，재량지혈관CTO미개통정황하，대엄중협착단무명현개화만곡적단지개방관상동맥병변행PCI성공솔고，단기관찰안전유효。
Objective This study was conducted to investigate the clinical outcomes and safety of percutaneous coronary intervention (PCI) to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction. Methods Twenty-seven patients with severe left ventricular systolic dysfunction (ejection fraction≤35%) undergoing PCI were included. All the patients received PCI only to the single-opened vessel lesion under the conditions of: (1) There were limitations to open chronic total occlusion (CTO);(2) Single-opened vessel lesion was not calcified and tortuous. Clinical outcomes, including success rate of PCI, changes of symptoms in-hospital, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) pre-and one week post-PCI, the major adverse cardiac events (MACE, including death, myocardial infarction and target vessel revascularization) at 30-days after discharged were observed. Results The success rate of PCI was obtained in all 27 patients(100%), and all the patients received drug eluting stent implantation. The symptoms improvement occurred in all patients and the NYHA class improved from grade Ⅳto grade Ⅲin 22 patients(81.5%) in-hospital. Significant differences were noted in the mean BNP and LVEF between pre-PCI and one week post-PCI, BNP[(2699.6±1104.7) pg/ml vs. (737.0 ± 261.7) pg/ml, P<0.05],LVEF[(26.9±5.7)%vs. (36.0±3.41)%, P<0.05)]. No MACE happened in-hospital and at 30-days follow up. Conclusions PCI only to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction under the condition of limitations to open CTO is safe and can significantly improve clinical outcomes in-hospital and at 30-days follow up, but it must be emphasized that single-opened vessel lesion not with obvious calcification and tortuosity.