Abstract:Aim To compare the middle and long term prognosis and analyze the influencing factors of chronic total occlusion (CTO) in different branches of coronary artery after percutaneous coronary intervention (PCI) revascularization. Methods A total of 122 patients with CTO confirmed by selective coronary angiography were divided into different branches of lesions according to the lesion location of CTO(left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)). 113 of them were tried to implement PCI, and the prognosis (survival rate, major adverse cardiac events, left ventricular function) of those with successful PCI and non-revascularization (including unsuccessful PCI and non-PCI) were observed through following up. The middle and long term effects of different branches of CTO after revascularization were compared, and the clinical factors that affect the prognosis were analyzed. Results Among the 113 CTO patients who underwent PCI, 81 cases were successfully revascularized (including 30 cases of RCA, 32 cases of LAD, 5 cases of LCX and 14 cases of two or more branches lesions). The cumulative event-free survival rate in the successful PCI revascularization group was significantly higher than that in the non-revascularization group (70.4% vs 58.5%, P=0.042) during the mean follow-up of (26.7±20.7) months, and the total incidence of adverse events was significantly lower than that in the non-revascularization group (24.7% vs 56.1%, P=0.021). In RCA group, LAD group and two or more CTO lesions group, the incidence of recurrent angina pectoris, heart failure, MACE and all-cause death in those successfully treated with revascularization were significantly lower than that of non-revascularization group (P value of these groups was 0.2,0.7,0.013, respectively). There was no significant difference in LCX group (P=0.408). The total increased left ventricular EF ((3.1±1.4)%) after successful PCI in all patients with CTO was significantly higher than that in the non-revascularization group ((0.3±1.2)%, P=0.038). The ΔEF ((3.6±1.7)%, (4.1±1.8)%,Pü value =0.5,0.038), ΔLAD (P value =0.1,0.035), ΔLVEDD (P value=0.2,0.024), ΔLVESD (P value=0.8,0.031) and ΔRAD (P value=0.7,0.028) after successful revascularization in the RCA group and LAD group was significantly different compared with the same group of patients without revascularization. There was no significant difference about ΔEF(P value=0.5,0.475), ΔLAD (P value = 0.5,0.236), ΔLVEDD (P value=0.7,0.381), ΔLVESD (P value =0.8,0.341), ΔRAD (P value =0.6,0.256) in LCX group and two or more branches group after successful PCI revascularization. Cox proportional risk regression analysis showed that the prognostic factors of CTO patients after PCI revascularization included diabetes history (95%CI:1.253～8.449, P=0.015), serum total bilirubin (95%CI:0.874～0.996, P=0.038), serum uric acid levels(95%CI:1.001～1.007, P=0.006) and J-CTO scores (95%CI:1.135~5.325, P=0.012). Conclusions Successful PCI revascularization of coronary CTO lesions can improve the overall cumulative event-free survival rate in the middle and long term. However, there are differences in the incidence of recurrent angina pectoris, heart failure, MACE, all-cause death and the improvement of left ventricular EF in different branches of CTO lesions. Diabetes history and higher J-CTO scores increases the risk of middle and long term death in CTO patients.

Abstract:Aim To explore the effect of levosimendan on survival and prognosis of elderly patients undergoing coronary artery bypass grafting (CABG). Methods 84 elderly patients with coronary heart disease undergoing selective CABG were randomly divided into treatment group (44 cases) and control group (40 cases). 10 minutes before cardiopulmonary bypass, levosimendan was administered in treatment group for 24 hours, and equal amount of normal saline was administered instead of levosimendan in control group. Mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), mixed venous oxygen saturation (SvO2), systemic vascular resistance index (SVRI) and cardiac index (CI) were monitored. The postoperative incidence of low cardiac output syndrome (LCOS), intensive care unit (ICU) stay time, ventilator assist time, intra-aortic balloon pump usage and norepinephrine usage were compared between the two groups. Postoperative follow-up of 180 days, the event-free survival rate was compared between the two groups. Results The levels of CI and MAP in the treatment group at 2 and 24 hours after operation were significantly higher than those in the control group (P＜0.05), while the levels of SVRI and PCWP in the treatment group were significantly lower than those in the control group (P＜0.05). The postoperative incidence of LCOS, ICU stay time, ventilator assist time and norepinephrine use rate in the treatment group were significantly lower than those in the control group (P＜0.05). The 180-days event-free survival rate was 88.5% in the treatment group and 67.1% in the control group, and Log-rank test showed that there was a significant difference in the event-free survival rate between the two groups (P＜0.05). Conclusion Levosimendan can improve the postoperative hemodynamic indexes of elderly CABG patients, prevent and treat LCOS, increase the event-free survival rate after operation, and improve the clinical prognosis of patients.