踝臂指数预测干预方式不同的冠心病患者发生心血管事件的价值

Usefulness of ankle-Brachial Index to Predict Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Different Intervention

目的:评价踝臂指数(ABI)预测经选择性冠状动脉造影确诊、但干预方式不同的冠心病(CHD)患者发生心血管事件的预测价值。方法:自2004年9月7日-12月30日,对接受冠状动脉造影检查的连续的142例患者于手术前进行ABI测量,并收集人口统计学资料、病史、生化检查、冠脉造影结果、血运重建措施及药物治疗情况;前瞻性观察经冠状动脉造影证实的CHD患者的心血管事件的发生情况。ABI异常定义为ABI≤0．9。结果:117(82．4％)例患者经冠状动脉造影检查证实为CHD,其中37(31．6％)例患者ABI异常;100(85．5％)例患者接受了血运重建治疗。平均随访(14．2±2．4)个月,共30例患者(25．6％)发生了心血管事件。预测事件的独立危险因紊包括糖尿病(P=0．044,OR=2．65, 95％CI,0．95-7．44),ABI(P=0．012,OR=3．73,95％CI,1．34-10．37)及未行血运重建治疗(P=0．018,OR=0．18,95％CI, 0．05-0．74)。结论:ABI异常是CHD患者发生心血管事件独立的危险因素。合并ABI异常的CHD患者接受冠状动脉血运重建治疗可降低1年内心血管事件的危险。

Objective： Resting ankle-brachial pressure index （ABI） is a nonmvasive method to assess the patency of the lower extremity arterial system. This study aimed to examine the relation between ABI and the prognosis of patients referred for elective coronary angiography with different intervention. Methods： From September 2004 to November 2004,142 consecutive patients underwent coronary angiography, and ABI evaluation. Among 142 patients, 117 patients were diagnosed as having CAD based on coronary angiography （82.4%） ,which were followed up for （14.2 ± 2.4） months. And 100 patients got the therapy of revascularization. The definition of cardiovascular events is cardiac death, nonfatal myocardial infarction, unstable angina, stroke and revascularization procedures. Results： During follow-up, there were 30 cardiovascular events. A relative good correlation between ABI and cardiovascular events （OR=3.73, 95%CI, 1.34-10.37,P=0.012）, the same with the diabete mellitus （OR=2.65, 95%CI, 0.95-7.44, P=0.044 ） and un-revascularization procedures （OR=0.18, 95%CI, 0.05-0.74, P=0.018）. Conclusion： ABI could be useful in assessing the risk for cardiovascular events in patients with coronary artery disease.