严重冠脉3支病变不同治疗策略的预后分析

Prognosis of severe three-vessel coronary disease in different treatment strategies

目的:分析严重冠脉3支病变不同治疗策略的预后情况及危险因素。方法:回顾性分析2012-11-2013-06冠状动脉(冠脉)3支病变患者305例,根据治疗策略分为经皮冠脉介入治疗(PCI)组138例、冠脉搭桥术(CABG)组93例及药物保守治疗组74例。比较12个月主要不良心脑血管事件(MACCE)发生率,并分析影响预后的危险因素。结果:药物治疗组MACCE发生率高于PCI及CABG组(P<0.05)。PCI组MACCE与CABG组差异无统计学意义(P>0.05)。脑卒中发生率CABG组高于PCI组(P<0.05)。再次血运重建率PCI组明显高于CABG组(P<0.05)。糖尿病史,空腹血糖(FBG),总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),脂蛋白a[LP(a)],左室射血分数(LVEF)及慢性完全闭塞病变(CTO)等指标为MACCE发生率的独立危险因素(OR>1,P<0.05)。结论:对于严重冠脉3支病变的患者,不同治疗策略的预后不同,其中药物保守治疗预后最差,而PCI与CABG在改善预后方面无明显差异。糖尿病史,FBG,TC,LDL-C,LP(a),LVEF及CTO病变可以独立预测患者的预后。

Objective：To analyze the prognosis and risk factors of the severe three-vessel coronary disease in different treatment strategies.Method：From November 2012 to June 2013,305 patients with pathological changes in three main coronary arteries were analyzed retrospectively.The patients were divided into 3groups,the percutaneous coronary intervention（PCI）group（n=138）,coronary artery bypass surgery（CABG）group（n=93）and conservative drug treatment group（n=74）.The incidence of major adverse cardiac and cerebral events（MACCE）was compared among different groups.The risk factors of prognosis were analyzed.Result：The incidence of MACCE of the drug treatment group was higher than PCI and CABG groups（P〈0.05）.There was no statistical difference in the incidence of MACCE between PCI and CABG group（P〉0.05）.The incidence of stroke in the CABG group was higher than the PCI group（P〈0.05）.The incidence of revascularization in PCI group was higher than that in CABG group（P〈0.05）.History of diabetes,Fasting Blood Glucose（FBG）,Total Cholesterol（TC）,Low Density Lipoprotein-Cholesterol（LDL-C）,Lipoprotein a（LP（a）,Left Ventricular Ejection Fraction（LVEF）and Chronic Total Occlusion（CTO）lesions were the independent risk factors for the incidence of MACCE（OR〉1,P〈0.05）.Conclusion：The prognosis of conservative drug therapy was the worst.There was no significant difference between PCI and CABG therapies in improving the prognosis.History of diabetes,FBG,TC,LDL-C,LP（a）,LVEF and CTO lesions could independently predict the prognosis of these patients.