冠状动脉慢性完全闭塞患者经皮冠状动脉介入治疗中DSA机X射线出束总时长的影响因素分析

Analysis of factors influencing total X-ray beaming duration of a digital subtraction angiography machine during percutaneous coronary intervention in patients with coronary artery chronic total occlusion

    摘要
  • 摘要:
    目的 探讨冠状动脉慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）中数字减影血管造影（DSA）机X射线出束总时长的影响因素。
    方法 回顾性分析2021年9月至2022年9月南华大学附属第一医院收治的224例CTO患者的临床资料，按照介入治疗中DSA机X射线出束总时长的中位数（50.55 mim）将患者分为2组：X射线出束总时长<50.55 min为较小出束时长组，共112例患者，其中男性74例、女性38例，年龄（59.0±10.0）岁；X射线出束总时长≥50.55 min为较大出束时长组，共112例患者，其中男性85例、女性27例，年龄（58.0±10.0）岁，2组手术均为同一组医师、护士、技师团队操作完成。应用病例对照研究分析2组患者差异化的风险因素，并将P≤0.2的风险因素纳入二元Logistic回归分析，以筛选出与较大出束时长（≥50.55 min）相关的独立风险因素。计量资料的2组间比较采用两独立样本t检验或Mann-Whitney U检验；计数资料的2组间比较采用χ2检验。
    结果  较大出束时长组患者左室射血分数（LVEF）<50%的比例明显高于较小出束时长组（35.71%对19.64%），且差异有统计学意义（χ2=7.226，P<0.05）。较大出束时长组冠状动脉病变因素中钙化、近端纤维帽模糊、左前降支远段闭塞的患者比例以及日本多中心慢性完全闭塞注册研究（J-CTO）评分明显高于较小出束时长组47.32%对29.46%、48.21%对31.25%、22.32%对10.71%、2（2，3）分对2（1，2）分，且差异均有统计学意义（χ2=7.550、6.730、5.471，Z=−3.507，均P<0.05）。较大出束时长组PCI治疗因素中仅股动脉穿刺、导丝数量、支架数量明显高于较小出束时长组23.21%对11.61%、11（8，12）根对9（7，11）根、2（1，3）根对2（1，3）根，且差异均有统计学意义（χ2=5.247，Z=−5.058、−2.179，均P<0.05）。二元Logistic回归分析结果显示，LVEF<50%、J-CTO评分、仅桡动脉穿刺、导丝通过病变及导丝数量与X射线较大出束时长（≥50.55 min）有较好的预测相关性（OR=0.467、1.471、2.159、0.345、1.397，均P<0.05），且Ominibus检验模型拟合程度良好（χ2=53.202，P<0.001），总体分类正确率达67.9%，预测性能良好。
    结论 LVEF<50%、J-CTO评分、仅桡动脉穿刺、导丝通过病变及导丝数量5项因素可以预测CTO-PCI术中X射线较大出束时长（≥50.55 min），为介入工作人员的职业辐射暴露与安全模型的建立提供了前期准备。

     

    Abstract:
    Objective  To explore factors influencing the total X-ray beaming duration of a digital subtraction angiography (DSA) machine during percutaneous coronary intervention (PCI) in patients with coronary artery chronic total occlusion (CTO).
    Methods  A retrospective analysis was conducted on the clinical data of 224 CTO patients admitted to the First Affiliated Hospital of University of South China from September 2021 to September 2022. According to the median value (50.55 min) of total X-ray beaming duration in CTO-PCI, two groups were established: small-beaming-duration group, which included 112 patients (74 males, 38 females) with total X-ray beaming duration<50.55 min, aged (59.0±10.0) years, and large-beaming-duration group, which included 112 patients (85 males, 27 females) with total X-ray beaming duration≥50.55 min, aged (58.0±10.0) years. The operations of two groups were achieved by the same team of cardiologists, nurses, and technicians. A case-control study was used in analyzing differences in risk factors between two groups, and risk factors with P≤0.2 were included in a binary Logistic regression model for the identification of factors influencing large beaming duration (≥50.55 min). The comparison of measurement data between the groups was performed with two-independent-samples t-test or Mann-Whitney U test. The enumeration data of the groups were compared with chi-square test.
    Results  The large-beaming-duration group had a significantly higher number of patients with left ventricular ejection fraction (LVEF)<50% than the small-beaming-duration group (35.71% vs. 19.64%), and the difference was statistically significant (χ2=7.226, P<0.05). The number of patients with calcification, blurred proximal fiber cap, and distal left anterior descending artery lesions and Japanese multicenter-CTO registry (J-CTO) scores in the large-beaming-duration group were significantly higher than those in the small-beaming-duration group (47.32% vs. 29.46%; 48.21% vs. 31.25%; 22.32% vs. 10.71%; 2 (2, 3) scores vs. 2 (1, 2) scores), and the differences were statistically significant (χ2=7.550, 6.730, 5.471; Z=−3.507; all P<0.05). Punctured femoral artery only, number of guidewires used, and number of stents used in the large-beaming-duration group were significantly higher than those in the small-beaming-duration group (23.21% vs. 11.61%; 11 (8, 12) items vs. 9 (7, 11) items; 2 (1, 3) items vs. 2 (1, 3) items), and the difference was statistically significant (χ2=5.247; Z=−5.058, −2.179; all P<0.05). Results of binary Logistic regression analysis showed that LVEF<50%, J-CTO score, punctured radial artery, wire passage through the lesion, and the number of guidewires can predict extended X-ray beaming duration (≥50.55 min) during CTO-PCI (OR=0.467, 1.471, 2.159, 0.345, 1.397; all P<0.05), and the Ominibus test model had a good fitting degree (χ2=53.202; P<0.001). The overall classification accuracy rate reached 67.9%, and the prediction performance was good.
    Conclusion  Five factors, namely, LVEF<50%, J-CTO score, punctured radial artery, wire passage through the lesion, and the number of guidewires can be used in predicting extended X-ray beaming duration (≥50.55 min) during CTO-PCI and facilitate the construction of occupational radiation exposure and occupational safety models for interventional medical staff.

     

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