左心室收缩功能正常的老年冠心病患者无保护左主干病变PCI治疗预后的影响因素

Factors influencing prognosis in percutaneous coronary intervention for unprotected left main coronary disease in elderly coronary heart disease patients with normal left ventricular systolic function

目的探讨左心室收缩功能正常(左心室射血分数≥40%)的老年冠状动脉粥样硬化性心脏病(冠心病)患者无保护左主干(unprotected left main,ULM)病变经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗预后的影响因素。方法回顾性分析2009年1月至2011年12月在广西壮族自治区人民医院因ULM接受PCI治疗的左心室收缩功能正常的患者112例的临床资料和冠状动脉造影结果。根据患者的情况分为非老年组(年龄<60岁)和老年组(≥60岁),比较两组间的基线资料和冠状动脉造影结果。应用多因素回归分析法观察年龄对ULM介入治疗结果的预测价值。结果总计入选符合条件的患者112例,其中非老年组42例和老年组70例。老年组糖尿病、高脂血症、吸烟史、既往PCI治疗、主要心脑血管不良事件(MACCE)、术后心肌梗死发生率明显高于非老年组,差异有统计学意义(分别为42.9%vs.21.1%,P=0.021;40%vs.11.9%,P=0.040;28.6%vs.9.5%,P=0.017;18.6%vs.4.8%,P=0.038;48.6%vs.23.8%,P=0.009;22.9%vs.0%,P=0.001)。Logistics回归分析得出女性、年龄、吸烟史、合并多支血管病变、远端或分叉病变均为主要心脑血管不良事件的独立预测因素。结论左心室收缩功能正常的患者,其年龄因素是ULM介入治疗预后不良的强力预测因素。

Objectives To evaluate the factors influencing prognosis in percutaneous coronary intervention（PCI） for unprotected left main （ULM） coronary disease in elderly coronary heart disease patients with normal left ventricular systolic function.Methods The relevant baseline and outcome data of 112 patients undergoing PCI for ULM disease in elderly coronary heart disease patients with normal left ventricular systolic function in The People＇s Hospital of Guangxi Zhuang Autonomous Region were collected from January 2009 to December 2011.The enrolled patients were divided into two groups according to the age：younger group （age〈60 years,n=42） and elderly group （age≥60 years,n=70）.The baseline and outcome data were compared between the two groups.Multivariate regression analysis was performed to appraise the prognostic role of age in patients undergoing PCI for ULM disease.Results Diabetes mellitus,hyperlipidaemia,smoking history,previous PCI,major adverse cardiovascular and cerebral vascular event （MACCE） and myocardial infarction rate were higher in elderly group than in younger group （42.9% vs.21.1%,P=0.021 ; 40% vs.11.9%,P=0.040; 28.6% vs.9.5%,P=0.017; 18.6% vs.4.8%,P=0.038; 48.6% vs.23.8%,P=0.009; 22.9% vs.0%,P=0.001 ; respectively）.Female gender,age ≥ 60 years,smoking history,complicated with multi-vessel disease,left main coronary artery distal or bifurcation lesion were independent predictors of MACCE by Logistic regression analysis.Conclusions Age over 60 years is the strongest predictor in PCI for ULM disease in coronary heart disease patients with normal left ventricular systolic function.