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Objective: coronary chronic total occlusion (CTO) is a percutaneous coronary intervention (PCI) field is one of the most difficult types of lesions. CTO lesions successfully launched the long-term survival of the patient so far is still controversial. This study aimed to evaluate the long-term success of opening CTO lesions clinical efficacy, and to explore multi-vessel disease, multivessel CTO and drug-eluting stents (DES) implantation for CTO lesions after the opening of the long-term therapeutic effect. Methods: A retrospective analysis from June 1993 to December 2007 in our hospital Cardiology 1604 consecutive patients hospitalized cases of coronary CTO clinical data, disease characteristics, PCI results and long-term efficacy. PCI were divided into groups according to the success (n = 1447) and the failure group (n = 157), compared two groups of long-term survival, MACE-free survival, cardiac function and the demand for CABG difference; successful group then divided into single with multi-vessel vascular CTO CTO, single-vessel disease with multi-vessel disease, implantation of DES versus bare-metal stents (BMS) in different subgroups, followed by analysis of the clinical efficacy differences between the groups. CTO lesions defined as: coronary occlusion three months or more, PCI before \Target lesion PCI success was defined as percutaneous transluminal coronary angioplasty (PTCA) postoperative residual stenosis of the target lesion diameter lt; less than 50% residual stenosis or coronary artery stenting lt; 30%, forward flow reached TIMI 3, and no serious complications. Success was defined as cases of subendocardial blood vessels and main branches of functionally important vascular lesions CTO PCI success. Major adverse events (MACE) defined as: death, non-fatal myocardial infarction (MI) or target vessel revascularization (TVR, including PCI or coronary artery bypass grafting). Results: The patients overall success rate was 90.2% of cases (1447/1604), the lesion success rate was 87.1% (1669/1916). Success and failure groups compared with the average age, proportion of males, smoking history, history of hypertension, hypercholesterolemia, diabetes mellitus, MI history and types of coronary heart disease were not statistically different (P all gt; 0.05), CTO success group time gt; 6 months was lower than the failure group [56.2% (813/1447) than the 89.2% (140/157), P lt; 0.01]. Coronary angiography showed single-vessel disease 339 cases (21.1%), double vessel disease 692 cases (43.1%), three vessel disease 573 cases (35.7%). CTO target vessel Cases: single vessel 1346 cases (83.9%), double vessel 235 cases (14.7%), three vessels 23 cases (1.4%). Failure group heavily calcified, severe vascular tortuosity, there is significantly higher than the proportion of the bridge collateral success group, occlusive vascular segment length is significantly longer than the success group (P lt; 0.05). Successfully relieve the symptoms of angina after PCI group was higher than the failure group (87.6% higher than 65.8%, P lt; 0.01), MACE rate during hospitalization was also significantly lower than the failure group [1.8% (26/1447) ratio of 5.1% (8 / 157), P lt; 0.01]. Two groups were followed up for an average of 58.4 ± 46.1 and 56.8 ± 45.3 months, and clinical follow-up rate was 98.9% and 98.7%, successful 10-year survival of patients (77.6% vs 66.2%, P lt; 0.05), and 10-year MACE survival rate (51.4% higher than 33.4%, P lt; 0.05) was significantly higher than the failure group, underwent CABG treatment was significantly less than the failure group (4.6% vs 14.5%, P lt; 0.01). After PCI 6.6 ± 2.7 months echocardiography results showed that before surgery determined dysfunction (LVEF lt; 0.5) after the successful launch CTO preoperative LVEF values ??above (50.2 ± 5.7% higher than 44.5 ± 3.2%, P lt; 0.05); patients with normal cardiac function after successful launch CTO compared with the preoperative LVEF value was no significant difference (57.3 ± 4.9% higher than 56.2 ± 4.3%, P gt; 0.05). CTO patients successfully launched its 10-year survival rate was significantly higher than single multi-vessel CTO CTO group (83.1% higher than 71.3%, P lt; 0.05), single-vessel disease group than in multi-vessel disease (86.3% than 76.4%, P lt; 0.05). After the successful launch earlier CTO BMS implantation of DES implantation in patients with both groups were followed 29.4 ± 18.7 (6 ~ 58) months versus 28.6 ± 18.1 (6 ~ 58) months, the two groups of mortality and incidence of myocardial infarction no significant difference (3.7% versus 4.5%, 6.7% vs 8.5%, P both gt; 0.1), but the DES group TVR (12.4% higher than 27.5%, P lt; 0.005) and MACE rate (14.7%, 30.2% P lt; 0.005) was significantly lower than the BMS group. Conclusions: (1) open CTO lesions can significantly relieve angina symptoms and improve long-term survival, lower risk of MACE, reduce future demand for CABG and to heart dysfunction, cardiac function improved significantly. (2) patients with multivessel disease after opening CTO lesions can reduce cardiac risk; (3) opening of CTO lesions after DES implantation can significantly reduce the risk of MACE, long-term clinical efficacy is superior to BMS implantation.
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