伴缺血性脑卒中史的急性冠状动脉综合征患者介入治疗的随访研究

Follow-up of elderly acute coronary artery syndrome patients with ischemic stroke history after PCI

目的探讨70岁以上伴或不伴缺血性脑卒中史的急性冠状动脉综合征(acute coronary syndrome,ACS)患者行PCI术后1年主要不良事件有无差异,并分析影响患者预后的主要因素。方法回顾性分析我院心内科住院诊断为ACS,既往合并缺血性脑卒中、并行PCI的患者130例(试验组),选取同期住院,年龄、性别与其相匹配的ACS患者130例(对照组)。记录患者临床资料、血管造影结果、置入支架数目,随访时间1年,记录主要不良事件(心源性死亡、脑卒中、靶血管再次血运重建、支架内血栓、主要出血事件)发生率。结果试验组PCI后脑卒中比例高于对照组(6.2%vs 1.5%),但差异无统计学意义(P>0.05)。logistic回归分析显示,主要不良事件发生率与肌酐水平、ACS分型及缺血性脑卒中史相关。结论既往患有缺血性脑卒中合并ACS行PCI患者,脑卒中发生率增高,并成为主要不良事件发生的影响因素。

Objective To study the major adverse events in 〉70 years old acute coronary syndrome （ACS） patients with or without acute ischemic stroke （AIS） history 1 year after PCI and analyze the major factors influencing their outcomes .Methods One hundred and thirty ACS patients with AIS history admitted to our department served as an experimental group and 130 age‐and gender‐matched ACS patients served as a control group in this study .The patients were followed up for 12 months ,during w hich their clinical data ,angiographic data ,placed stents ,major adverse events （cardio‐genic death ,ischemic stoke ,target vessel revascularization ,stent thromrosis and bleeding ） were recorded .Results The incidence of ischemic stroke was not significantly higher in experi‐mental group than in control group after PCI （6 .2% vs 1 .5% ,P〉0 .05） .Logistic regression anal‐ysis showed that the incidence of major adverse events was related with the creatinine level ,types of ACS and ischemic stroke history .Conclusion The incidence of ischemic stroke is high in pa‐tients with AIS histry and is the risk factor for major adverse events after PCI .