10年来冠心病行PCI治疗患者的危险因素的变化趋势研究

Trend of Patients Characteristice and Efficacy in Percutaneous Coronary Intervention during the past 10 Years

目的探讨十年来冠心病PCI治疗患者的主要危险因素的变化趋势。方法回顾分析2003年和2013年全年上海长海医院收治并行冠脉内支架植入术冠心病患者的临床资料。比较2003年和2013年两组患者的年龄、吸烟史及血脂水平等主要危险因素、冠脉病变、冠脉内支架植入情况的差异。结果2003年入组患者共240例，2013年组为1254例；平均年龄、女性患者比例及高血压、糖尿病发病率无明显统计学差异。2013年吸烟比例2003年的51．9％降至35．7％（P〈0．01），高密度脂蛋白水平升高（P〈0．01）。2013年冠脉多支病变比例从2003年的26．3％上升至45．1％（P〈0．01）；复杂病变的比例从35．8％增加至53．5％（P〈0．01）；植入支架个数从1．38±0．61增加至1．64±0．84（P〈0．01）；植入支架总长度由（27．30±14．95）mm增长至（40．20±24．12）mm（P〈0．01）。2013年组患者住院期间死亡率为0．3％，较2003年组1．7％相比有所下降（P〈0．05）。结论本院冠心病PCI治疗患者的主要危险因素与10年前比，吸烟比例下降，高密度脂蛋白胆固醇上升。尽管冠脉三支病变、复杂病变比例增加，使得植入支架的数量和长度增加，但术中和术后并发症及死亡率明显降低。

Objective To investigate the trends of treatment characteristics with PCI during the past decade. Methods This study recruided the patients with stent implantation in Shanghai Changhai Hospital in 2003 and 2013. The purpose of this study is to look at the trends of risk factors, including mean age, current smoker, serum cholesterol levels and coronary artery lesions, stent implantation in patients with PCI during the past 10 years. Results There were 240 cases in 2003 group and 1254 cases in 2013 group. There was no significant difference between the two groups in patients＇ age, gender ratio .And were also no significant difference between those two groups of patients in hypertension, and diabetes, dyslipidemia ratio. However, the smokers in group of 2013 were significantly decreased （35.7% and 51.9%, respectively, P 〈0.05）. Compared with the 2003 group, patients of 2013 group had a higher serum levels of HDL-C （P 〈0.01）. The proportion of multiple-vessel disease in 2013 was increased from 26.3% in 2003 to 45.1% in 2013 （P 〈0.01）. The percentage of complex coronary lesions increased from 35.8% to 53.5% （P 〈0.01）.The average number of stents （1.64±0.84 vs 1.38±0.61, P 〈0.01） and the total length of stents[（40.20 ±24.12） mm vs （27.30± 14.95） mm ,P 〈0.01] implanted for each patient were increased significantly in 2013 as compared with those in 2003. In 2013, the mortality rate of patients in hospital was 0.03%, decreased significantly compared with 1.7% in 2003 （P 〈0.05）. Conclusions Compared with those in 10 years ago, patients＂ risk factors undergoing PCI in recent year had lower proportion of smokers and higher serum levels of HDL-C. Though the proportion of patients with muhiple-vessel disease and complex coronary lesions increased, the number and length of stents implanted for each patients increased as well, complications and mortality during and post procedure were significantly decreased.