伴缺血性脑卒中史的急性冠脉综合征患者介入治疗的随访研究

Treatment follow-up study with a history of ischemic stroke in patients with acute coronary syndrome intervention

目的通过随访探究伴不伴缺血性脑卒中史的急性冠脉综合征患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的预后情况,为其治疗方案的选择和决策提供临床循证治疗的依据。方法连续纳入2010年6月—2014年6月入住本院心内科住院部、被诊断为急性冠脉综合征、既往有缺血性脑卒中史、接受PCI的患者80例作为观察组。通过1:1匹配选取同时期不伴缺血性脑卒中史的该类患者80例作为对照组。手术后随访1年,每3个月由管床医生采用门诊和电话随访,记录各项不良事件作为观察终点。采用卡方χ2检验或Fisher检验比较两组不良事件发生率的差异。采用Kaplan-Meier生存分析两组结局情况,用Log-Rank检验比较两组预后情况,通过Cox危险因素回归分析,分析各潜在影响因素与不良事件发生的关系。P<0.05为差异有统计学意义。结果随访1年中,各项及总体不良事件的发生率在两组患者中比较差异均无统计学意义(均P>0.05)。通过Kaplan-Meier生存分析可知,观察组1年后总体不良事件未发生率为65.7%,对照组1年后总体不良事件未发生率为71.2%,Log-Rank分析认为两组对比差异无统计学意义(P>0.05)。通过Cox危险因素回归,发现脑卒中史、肌钙蛋白I峰值、肌酐与患者发生不良事件无关(P>0.05),急性冠脉综合征分型、病变部位分级、钠尿肽与患者发生不良事件有关(P<0.05)。结论在综合考虑患者情况后,可以将PCI作为伴缺血性脑卒中史的急性冠脉综合征患者的有效干预手段之一,本研究能够为治疗方案的选择和决策提供初步的临床循证依据,但仍待进一步研究。

Objective By following up,we explored the long term prognosis of percutaneous coronary intervention（ PCI） treatment in patients with acute coronary syndrome with a history of ischemic stroke,to provide clinical evidence for treatment choices and decisions.Method 80 patients with acute coronary syndrome with a history of ischemic stroke, who underwent PCI treatment were included continuously in the observation group.By 1：1 matching,80 patients with acute coronary syndrome without a history of ischemic stroke,who underwent PCI treatment were selected as control group. All of them were followed up for 1 year after the treatment, and adverse events were measured as the end point. Chi- square test, Fisher＇s test,Kaplan- Meier survival analysis and Log- rank were performed to evaluate and compare the long term prognosis. Cox regression were performed to explore the relationship between several potential risk factors and the long term prognosis of PCI treatment.The resule of P〈0.05 was considered statisically significant.Results After 1 year follow up, there were no significant statistical differences of specific and overall occurrence of adverse events among the patients in two groups（P〉0.05）.From Kaplan- Meier survival analysis, the probability for patients in observation group haven＇t got adverse events after 1 year follow up was 65.7%, and the probability for patients in control group haven＇t got adverse events after 1year follow up was 71.2%.According to Log- rank test, there was no significant statistical difference（P〉0.05）.By Cox hazard regression, it was found that a history of stroke, the level of cardiac troponin I peak, the level of creatinine were not related with overall occurrence of adverse events among patients（P〉0.05）.The type of acute coronary syndrome,lesion classification, the level of natriuretic peptide were related with overall occurrence of adverse events among patients（P〈0.05）.Conclusion The long term prognosis of PCI treatment in patients with acute coronary syndrome with a history of ischemic stroke was proved to be optimistic. After considering the patients＇ condition,PCI treatment can be an effective intervention to improve the prognosis in patients and acute coronary syndrome with a history of ischemic stroke. This study provided preliminary evidence for clinical decision making, but further studies are still needed.