部分血运重建后优化药物治疗对三支冠脉病变患者疗效的临床分析

ANALYSIS OF CLINICAL OUTCOME TO OPTIMIZING DRUG THERAPY IN PATIENTS WITH THREEVESSEL CORONARY ARTERY DISEASE

目的探讨部分血运重建后优化药物治疗对三支血管病变患者的疗效及影响其预后危险因素。方法回顾性分析2012年1—12月于该院行经皮冠脉造影(coronary angiography,CAG)明确为三冠脉病变并行经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)106例患者临床资料,术后对1年随访患者冠脉造影及主要不良事件(major adverse cardiovascular events,MACE)进行随访,采用多因素Logistc回归分析法分析影响其预后的危险因素。结果随访1年复查造影不完全血运重建患者有63例患者未干预冠脉病变较前无变化或减轻,总有效率为84%(63/75)。临床指标达标57例,其中52例(94.7%)未干预冠脉病变较前无变化或减轻,5例(5.3%)较前加重;临床指标未达标18例,其中11例(61.1%)未干预冠脉病变较前无变化或减轻,7例(38.9%)较前加重;临床指标达标患者随访CAG总有效率明显高于未达标者(94.7%比61.1%,χ2=7.127,P<0.05)。随访1年不完全血运重建患者MACE发生率不完全血运重建患者较完全血运重建患者差异无统计学意义(18.7%比18.2%,P>0.05)。影响不完全血运重建患者PCI术后预后的危险因素为:糖尿病(P=0.044),心力衰竭(P=0.009),血清肌酐≥100μmol/L(P=0.040),合并左主干病变(P=0.025)。结论对三支血管病变患者行不完全血运重建优化药物治疗安全有效;糖尿病、心衰、血清肌酐≥100μmol/L、合并左主干病变是影响其预后的独立危险因素。

Objective To study efficacy and investigate the risk factors of patients with three-vessel coronary artery disease after optimizing drug therapy.Methods A retrospectively analysis was reviewed on the clinical date of 106 patients with three-vessel coronary artery disease clearly base on coronary angiography（CAG）,and suffered coronary angioplasty（PCI）,form January 2012 to December 2012 in author＇s hospital.Followed-up CAG and major adverse cardiovascular events and analyzed the dangerous factors influencing its prognosis by multi-factor Logistic analysis.Results Totally 63 patients showed no change or improvement in the coronary artery lesions that had not been intervened,the total effective rate was（84%,63/75）after 1 year.There were 57 patients achieved the clinical targets of optimizing drug therapy,among of them,52 patients showed no change or improvement in the coronary artery lesions that had not been intervened,but 8 patients have been increased;18 patients did not meet the clinical targets of optimizing drug therapy.Among of them,11 patients showed no change or improvement in the coronary artery lesions that had not been intervened,while 8 patients had been increased.The total effective ratio of optimizing drug therapy in patients meeting clinical targets was 94.7% compared to 61.1% in patients who failed（χ2=7.127,P〈0.05）.It was not obviously different incomplete revascularization and complete revascularization about the rate of MACE（20% vs 18.2%,P〉0.05）.The risk factors of affecting 0.009）,serum creatinine greater than or equal to 100 umol/L（P=0.040）,with left main lesion（P=0.025）.Conclusions It is feasible to choose incomplete revascularization therapy for patients with triple vessel diseases.The dangerous factors of influencing prognosis to incomplete revascularization in patients with three coronary artery disease were Diabetes,heart failure,serum creatinine greater than or equal to 100 umol/L,and with merge left main lesion.