经皮冠状动脉介入治疗对既往冠状动脉旁路移植术的冠状动脉慢性完全闭塞冠心病患者生活质量的影响

目的 观察经皮冠状动脉介入（PCI）治疗对既往冠状动脉旁路移植术（CABG）的冠状动脉慢性完全闭塞（CTO）患者生活质量的影响。 方法 连续性纳入2010年8月至2018年8月在西京医院心血管内科成功行PCI的123例患者，分为非CABG组和CABG组。收集病历资料，随访主要心血管事件（MACE），通过SAQ量表和SF-12量表比较患者生活质量的改变。 结果 CABG组患者的左室射血分数（LVEF）和低密度脂蛋白胆固醇（LDL-C）显著低于非CABG组（P<0.01）。影像学中CABG组患者的左主干（LM）合并两支或三支冠脉病变的比例高于非CABG组，而非LM单支或两支冠脉病变比例低于非CABG组（P<0.05，P<0.01）。随访时间为PCI术后（47±3）月，CABG组患者的全因病死率高于非CABG组，在非致死性心肌梗死和临床驱动的再次血运重建率中，非CABG组高于CABG组，但差异均无统计学意义。CABG组患者的SAQ量表中躯体活动受限程度的评分高于非CABG组（68±7）vs（59±2）分]，心绞痛稳定程度的评分高于非CABG组（70±9） vs （46±6）分]，心绞痛发作频率的评分也高于非CABG组（88±8） vs （80±6）]，差异均具有统计学意义（P<0.05）。而在治疗满意程度和疾病认知程度方面无明显差异。CABG组患者的SF-12量表中生理得分高于非CABG组（46±5）vs （39±4）分，P<0.05]，但两组的心理得分的差异无统计学意义。 结论 成功PCI使既往CABG的CTO冠心病患者心绞痛症状及生活质量得到改善。

Impact of PCI on the quality of life in coronary heart disease patients of CTO with previous CABG

AIM To observe the impact of percutaneous coronary intervention (PCI) on the quality of life of chronic total occlusion (CTO) patients with previous CABG. METHODS 123 CTO patients with successful PCI from the Department of Cardiology, Xijing Hospital from August 2010 to August 2018 were enrolled continuously. All these patients were divided into two groups: non-CABG group and CABG group. The clinical data of patients were collected. Postoperative major adverse cardiovascular events (MACE) were followed up. The changes of quality of life between two groups were compared by Seattle angina pectoris scale (SAQ) and SF-12 scale. RESULTS The LVEF values and LDL-C of patients in the CABG group were obviously below the non-CABG group (P<0.01). In the imaging results, the proportion of LM combined with two or three coronary lesions in CABG group was obviously higher than that of non-CABG group, and the proportion of non-LM single- or two-coronary lesions in CABG group was significantly lower than that of non-CABG group (P<0.05, P<0.01). During the average follow-up time after PCI (47±3 months), the all-cause mortality rate of patients in CABG group was higher than that of non-CABG group and the rate of recurrent non-fatal myocardial infarction and clinically driven revascularization in non-CABG group is higher than that of CABG group, but there was no significance between two groups. The scores for physical activity limitation of SAQ in CABG group were higher than that of non-CABG group (68±7) vs. (59±2)], the scores for angina pectoris steady state of SAQ in CABG group were higher than that of non-CABG group (70±9) vs. (46±6)] and the scores for angina pectoris attack frequency of SAQ in CABG group were obviously higher than that of non-CABG group (88±8) vs. (80±6)], the difference was statistically significant (P<0.05). However, there was no significant difference in treatment satisfaction and disease cognition. The physiological scores of SF-12 scale in CABG group were significantly higher than that of non-CABG group (46±5) vs. (39±4), P<0.05)]. But the psychological scores of the two groups were not statistically significant. CONCLUSION Successful PCI improves the angina symptoms and quality of life of CTO patients with previous CABG.