血管紧张素Ⅱ对行择期经皮冠状动脉介入治疗患者院内预后的预测作用

Angiotensin Ⅱ in Predicting the In-hospital Prognosis of Patients Undergoing Elective Percutaneous Coronary Intervention

目的探讨血浆血管紧张素Ⅱ水平对行择期经皮冠状动脉介入治疗患者院内预后的预测作用。方法连续纳入2012年7月至2013年7月在北京协和医院心内科住院行择期经皮冠状动脉介入治疗的患者645例,测定其血浆血管紧张素Ⅱ水平并记录其发生院内主要心血管不良事件情况。院内主要心血管不良事件定义：全因死亡、非致死性心肌梗死、新发非致死性卒中（缺血性及出血性）、非计划再次血管重建。分析血管紧张素Ⅱ水平与院内心血管不良事件的相关性。结果 645例患者中共有68例（10.54%）发生院内心血管不良事件,发生院内心血管不良事件者血浆血管紧张素Ⅱ水平显著高于未发生院内心血管不良事件者[41.42（28.73,57.07）ng/L比35.66（22.84,48.22）ng/L,P=0.009]。多因素Logistic回归分析显示血管紧张素Ⅱ为院内心血管不良事件的独立危险因素（比值比1.018,95%CI：1.004-1.032,P=0.012）。结论血浆血管张素Ⅱ水平与择期经皮冠状动脉介入治疗患者的院内不良预后相关,具有重要的预测价值。

Objective To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention. Methods From July 2012 to July 2013, 645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients, and in-hospital adverse cardiac events （including all-cause death, nonfatal myocardial infarction, new nonfatal ischemic stroke, new nonfatal hemorrhagic stroke, and unplanned vessel revascularization） were recorded. The relationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed. Results Among the 645 patients, 68 （ 10. 54% ） developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not [41.42 （28.73, 57.07） ng/L vs. 35.66 （22. 84, 48.22） ng/L, P =0. 009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events （ OR 1. 018, 95 % CI ： 1. 004 - 1. 032, P = 0.012）. Conclusion Plasma level of angiotensin Ⅱ may be correlated with poor in-hospital prognosis of patients who received elective percutaneous eoronary intervention, hence it may have important predictive value.