年龄对冠心病患者冠状动脉非靶病变快速进展的影响

Impact of Age on the Rapid Progression of Coronary Non-target Lesions in Patients With Coronary Heart Disease

目的:探讨年龄对冠心病患者冠状动脉非靶病变快速进展的影响。方法:回顾性分析我院2010年1月至2014年9月间接受连续两次冠状动脉造影检查且发现冠状动脉非靶病变的冠心病患者1255例。根据年龄分为青年组(<45岁,n=94)、中年组(45岁≤年龄<65岁,n=847)和老年组(≥65岁,n=314)三组。记录所有患者冠状动脉非靶病变的特征和定量冠状动脉造影结果并进行前后对比,评价三组患者冠状动脉非靶病变快速进展的情况。非靶病变快速进展的定义为冠状动脉造影随访时中度狭窄病变的直径狭窄率进展10%以上或轻度狭窄病变的直径狭窄率进展30%以上或病变进展至完全闭塞。如患者有2处及以上冠状动脉非靶病变,其中任一非靶病变出现快速进展,即认为该患者存在快速进展。结果:所有患者均在2年内完成两次冠状动脉造影检查,平均间隔时间14.8个月。与老年组比较,青年组和中年组男性和吸烟者比例更高,而老年组合并糖尿病、外周血管疾病及既往介入治疗的比例较青年组和中年组更高,差异均有统计学意义(P均<0.05)。在病变水平,青年组中病变快速进展的比例显著高于中年组和老年组[20.7%(24/116)vs.15.6%(175/1124)vs.12.1%(52/430),P=0.048]。在患者水平,青年组中有病变快速进展者的比例也高于中年组和老年组[25.5%(24/94)vs.19.4%(164/847)vs.16.2%(51/314),P=0.121]。三组患者在非靶病变血运重建、非靶病变相关心肌梗死及全部心肌梗死方面差异均无统计学意义(P均>0.05)。多因素分析显示,年龄(HR=0.984,95%CI:0.970~0.997,P=0.019)、高血压(HR=0.747,95%CI:0.570~0.981,P=0.036)和ST段抬高型心肌梗死(HR=1.422,95%CI:1.003~2.016,P=0.048)为非靶病变快速进展的独立影响因素,且老年组患者出现病变快速进展的风险显著低于青年组患者(HR=0.593,95%CI:0.354~0.993,P=0.047)。结论:年轻冠心病患者出现冠状动脉非靶病变快速进展的风险更高,应严格控制危险因素,警惕病变快速进展所引起的不良心血管事件。

Objectives:To investigate the impact of age on the rapid progression of coronary non-target lesions in patients with coronary heart disease.Methods:1255 patients with coronary non-target lesions,defined by two consecutive coronary angiographies at Fuwai Hospital from January 2010 to September 2014,were included in this retrospective analysis.Lesion characteristics of all coronary non-target lesions were recorded at both procedures.Rapid lesion progression was compared among groups of young age(age<45 years),middle age(45≤age<65)and old age(age≥65).Results:Serial coronary angiographies were all performed within two years.Mean follow-up interval was 14.8 months.The groups of young age and middle age were more often male and had higher rate of smoking history,while old age group had a higher prevalence of diabetes,peripheral artery diseases and percutaneous intervention history(all P<0.05).At the lesion level,young age group had significantly higher rate of rapid lesion progression than middle and old age groups(20.7%[24/116]vs.15.6%[175/1124]vs.12.1%[52/430],P=0.048).At the patient level,rate of patients with rapid progression in young age group tended to be higher compared with middle age and old age group(25.5%[24/94]vs.19.4%[164/847]vs.16.2%[51/314],P=0.121).The rates of nontarget lesion revascularization,non-target lesion related myocardial infarction and all myocardial infarction were similar among three groups(all P>0.05).Multivariate Cox regression analysis showed that age(HR=0.984,95%CI:0.970-0.997,P=0.019),hypertension(HR=0.747,95%CI:0.570-0.981,P=0.036)and ST-segment elevation myocardial infarction(HR=1.422,95%CI:1.003-2.016,P=0.048)were independent predictors for rapid progression,and old age group had a lower risk of rapid progression compared with young age group(HR=0.593,95%CI:0.354-0.993,P=0.047).Conclusions:Young patients with coronary heart disease are at a higher risk of rapid coronary non-target lesion progression.Strict strategies to reduce related risk factors should be applied and more attention should be paid to prevent future adverse cardiac events with coronary heart disease,especially in young patients.