预测冠心病患者冠状动脉介入术后长期效果的预测因素

Predictive factors for the long-term outcomes in patients undergoing percutaneous coronary intervention

目的:分析预测冠心病患者冠状动脉介入治疗术(PCI)后长期临床效果的预测因素。方法:收集592例冠心病患者PCI后的临床资料并进行随访,随访主要不良心血管事件(MACE)发生情况并经多元logistic回归的方法分析这些事件的相关因素。结果:平均随访时间18.96(3～57)个月。MACE的发生率为7.6%,全因性死亡率为2.4%,非致死性心肌梗死发生率为1.5%。MACE发生的预测因素有PCI方式、近段病变、参考血管的直径及氯吡格雷的应用时间,年龄、有心肌梗死史及氯吡格雷应用时间可预测全因性死亡,术后未戒烟及完全停止抗血小板治疗增加非致死性心肌梗死的危险。结论:高龄、单纯经皮冠状动脉球囊成形术或置入金属裸支架、小血管病变、近段病变和对抗血小板治疗及戒烟的依从性差是预测PCI后不良预后的因素。

Objective：To explore the predictive factors for long-term outcomes in patients undergoing percutaneous coronary intervention （PCI） in real world. Method：The clinical data was collected in 592 patients undergoing PCI in our department,major adverse cardiac events （MACE was defined as all-cause death,nonfatal myocardial infarction and coronary revascularization） was carefully recorded at follow-up,their relationship was analyzed by multi-variables stepwise logistic regression. Result：The average follow-up was 18.96 months（3-57 months）. At follow-up,the cumulative incidence of MACE was 7.6%,the all-cause morality was 2.4%,the prevalence of non-fatal myocardial infarct was 1.5%. The predictive factors for MACE were type of PCI,proximal lesion,referral coronary diameter,and the duration of prescribed clopidogrel. Age,previous myocardial infarction and premature withdrawal of clopidogrel were positively related to the all-cause death,current smoking and the discontinuation of antiplatelet therapy were associated with the increased risk of nonfatal myocardial infarction. Conclusion：The predictors for MACE include age,type of PCI,the smaller coronary artery,proximal lesion,nonadherence to antiplatelet therapy and cessation of smoking.