总胆红素对于急性冠状动脉综合征患者经皮冠状动脉介入治疗临床预后影响

Effect of total bilirubin on the prognosis of patients with acute coronary syndrome undergoing percutaneous coronary intervention

目的探讨总胆红素对于急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)临床预后的影响。方法选取北部战区总医院心血管内科自2016年11月至2017年5月收治的3693例接受PCI的ACS患者为研究对象。根据患者总胆红素水平将其分为A组(总胆红素<11.1μmol/L,n=1223)、B组(11.1μmol/L≤总胆红素≤15.6μmol/L,n=1255)、C组(总胆红素>15.6μmol/L,n=1215)。记录并比较3组患者的临床资料、冠状动脉造影结果、临床预后情况。对所有患者进行随访,主要终点为12个月主要心脑血管不良事件(MACCEs),包括卒中、心肌梗死、心源性死亡,次要终点为全因死亡以及MACCEs的独立组分。结果3组患者男性比例、吸烟史、临床诊断、肌酐清除率、左心室射血分数比较,差异均有统计学意义(P<0.05)。3组患者置入支架个数、置入支架总长度比较,差异均有统计学意义(P<0.05)。3组患者出院后12个月的MACCEs、全因死亡发生率比较,差异均有统计学意义(P<0.05)。结论总胆红素与ACS患者接受PCI后的临床预后具有相关性,尤其对MACCEs的发生风险具有预测价值。

Objective To investigate the effect of total bilirubin on the clinical prognosis of patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods A total of 3693 ACS patients who underwent PCI in the department of Cardiology,General Hospital of Northern Theater Command from November 2016 to May 2017 were selected as the research objects.According to the total bilirubin level,the patients were divided into group A(total bilirubin<11.1μmol/L,n=1223),group B(11.1μmol/L≤total bilirubin≤15.6μmol/L,n=1255)and group C(total bilirubin>15.6μmol/L,n=1215).The clinical data,coronary angiography results and clinical prognosis of the three groups were recorded and compared.All patients were followed up.The primary end point was 12-month major adverse cardiac and cerebrovascular events(MACCEs),including stroke,myocardial infarction,and cardiac death,and the secondary end point was all-cause death and independent components of MACCEs.Results There were significant differences in the proportion of males,smoking history,clinical diagnosis,creatinine clearance rate and left ventricular ejection fraction among the three groups(P<0.05).There were statistically significant differences in the number of stents implanted and the total length of stents implanted among the three groups(P<0.05).There were significant differences in the incidence of MACCEs and all-cause death among the three groups 12 months after discharge(P<0.05).Conclusion Total bilirubin is associated with the clinical prognosis of ACS patients after PCI,especially for predicting the risk of MACCEs.