王欢,郭宁,袁祖贻,黄欣
WANG Huan,GUO Ning,YUAN Zuyi,HUANG Xin

• 1:西安交通大学第一附属医院心内科

摘要(Abstract)：

目的:探讨多支病变稳定性冠心病(SCAD)患者的临床特点及经皮冠状动脉介入治疗(PCI)术后的远期预后。方法:以1 596例多支病变SCAD并具有PCI指征患者为研究对象,将患者分为MACE组(n=175)与非MACE组(n=1 421),比较2组患者入院时的临床基线资料(性别、年龄、既往病史),记录PCI术后随访3年的主要心血管不良事件(MACE)、实验室检测指标(白细胞计数、血红蛋白含量及血脂水平)、左心室射血分数(LVEF)、LVEF <40%患者比例、造影特征(双支病变、三支病变、左主干病变、弥漫病变、完全闭塞病变、钙化病变及支架数目)及出院后药物使用情况,采用多因素Cox回归分析MACE的危险因素。结果:多支病变SCAD患者PCI术后3年MACE的发生率为11.0%;与非MACE组患者相比,MACE组患者的年龄更大、男性比例更高、合并糖尿病更多、心脏功能更差、冠脉病变更复杂及冠脉支架数目更多,差异均具有统计学意义(P <0.05);多因素Cox回归分析显示,年龄、糖尿病、LVEF <40%和支架数目是发生远期MACE的独立危险因素。结论:多支病变SCAD患者接受规范冠心病二级预防药物治疗及PCI治疗后,仍具有较高的MACE发生率,尤其是高龄、糖尿病、LVEF降低及支架数目多是PCI治疗后发生MACE的独立危险因素。
Objective: To investigate the clinical features of patients with multivessel stable coronary artery disease( SCAD) and their long-term prognosis after percutaneous coronary intervention( PCI).Methods: One thousand five hundred and ninety-six patients with multivessel SCAD and PCI indication were enrolled. The major adverse cardiovascular events( MACE,including all-cause death,ischemia-driven revascularization,nonfatal myocardial infarction and stroke) were recorded for 3-year follow-up after PCI. The patients were divided into MACE group( n = 175) and non-MACE group( n= 1 421). We compared clinical baseline data( gender,age,previous medical history),MACE for 3 years after PCI,white blood cell count,hemoglobin content,blood lipid level,left ventricular ejection fraction( LVEF),the proportion of patients with LVEF < 40%,angiographic characteristics( doublevessel disease,triple-vessel disease,left main lesion,diffuse lesions,completely occlusive lesions,calcified lesions,stent number) and medication after discharge. The multivariate Cox regression was used to analyze the risk factors of MACE. Results: The incidence of MACE at 3 years after PCI in patients with multi-vessel SCAD was 11. 0%. MACE group had more elderly,males,diabetes,worse cardiac function,complicated coronary artery disease and the number of coronary stents than nonMACE group had( P < 0. 05). Multivariate Cox regression analysis showed that age,diabetes,LVEF< 40% and the number of stents are independent risk factors for the incidence of long-term MACE.Conclusion: Patients with multivessel SCAD have a high incidence of MACE after receiving secondary prevention medication of standard coronary heart disease and PCI. The elderly,diabetes,LVEF reduction and the number of stents are independent risk factors of MACE after PCI.

关键词(KeyWords)： 危险因素;稳定性冠心病;多支血管病变;经皮冠状动脉介入治疗;远期预后;主要心血管不良事件
risk factors;stable coronary artery disease(SCAD);multivessel lesion;percutaneous coronary intervention(PCI);long-term prognosis;major adverse cardiovascular events(MACE)

Abstract:

Keywords:

基金项目(Foundation): 陕西省重点研发计划(2017ZDCXL-SF-02-04-01);; 西安交通大学第一附属医院临床研究课题(XJTU1AF-CRF-2016-001,XJTU1AF-CRF-2019-014)

作者(Author): 王欢,郭宁,袁祖贻,黄欣
WANG Huan,GUO Ning,YUAN Zuyi,HUANG Xin

DOI: 10.19367/j.cnki.2096-8388.2020.08.021

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