高龄冠心病患者PCI后院内死亡危险因素分析

Risk factors of in-hospital mortality in elderly patients undergoing percutaneous coronary intervention

目的:探讨高龄冠心病患者接受经皮冠状动脉介入治疗(PCI)后发生院内死亡事件的危险因素。方法:连续入选我院2005年1月至2010年12月确诊为冠心病并接受PCI的高龄患者(年龄≥75岁)共1 007例,回顾性分析病历资料,通过单因素及多因素Logistic回归分析确定患者院内死亡的独立危险因素,并通过该多因素Logistic回归模型的受试者工作特征(ROC)曲线下面积和Hosmer-Lemeshow拟合优度检验,判断其对PCI后发生院内死亡事件的预测能力。结果:所有高龄冠心病患者中共33例发生院内死亡,死亡率为3.3%。PCI后患者院内死亡的独立危险因素包括急诊PCI(OR=8.59)、肾功能不全(OR=4.53)、急性心肌梗死(OR=6.83)、左室射血分数<50%(OR=3.53),左主干病变(OR=6.12)、C型病变(OR=5.90)、置入支架数≥3(OR=4.64),ROC曲线下面积为0.96,Hosmer-Lemeshow拟合优度检验P=0.48。结论:急诊PCI治疗、肾功能不全、急性心肌梗死、左室射血分数<50%、左主干病变、C型病变、置入支架数≥3是高龄冠心病患者PCI后发生院内死亡的独立危险因素,该回归模型对PCI后院内死亡事件的发生有较高的预测能力。

Objective： To investigate the risk factors of in-hospital mortality in elderly patients undergoing percutaneous coronary intervention （PCI） . Mcthods：A cohort of 1 007 consecutive elderly patients over 75 years old with coronary heart disease who underwent PCI from January 2005 to December 2010 was recruited in this study. Clinical data were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to determine the risk factors of in-hospital mortality. The area under the receiver operating characteristic （ROC） curve and the Hosmer-Lemeshow goodness of fit statistic were calculated to assess the performance and calibration of the model. Results： In 1 007 cases of elderly patients with coronary heart disease, 33 patients were dead, and the in-hospital mortality rate was 3.3%. Univariate and multivariate logistic regression analyses indicated that urgent PCI （OR = 8.59）, renal insufficiency （OR = 4. 53）, acute myocardial infarction （OR = 6. 83）, left ventriculer ejection fraction〈50% （OR = 3.53）, left main coronary artery disease （OR = 6.12）, type C lesion （OR= 5.90） and stents implanted≥3 （OR- 4.64） were independent risk factors of in hospital mortality. The area under ROC curve was 0.96 and P-value of Hosmer-Lemeshow goodness of fit test was O. 48. Conclusion：Urgent PCI, renal insufficiency, acute myocardial infarction, ejection fraction 50%, left main coronary artery disease, type C lesion and stents implanted 93 are independent risk factors of in-hospital mortality in elderly patients undergoing PCI and the model has excellent discrimination and calibration.