老年冠状动脉3支病变PCI血运重建策略对预后的影响

The prognoses of different PCI revascularization strategies of senior three-vessel coronary disease patients

目的:探究老年冠状动脉(冠脉)3支病变患者接受完全血运重建与不完全血运重建的远期预后差异。方法:入选我院2008-01-01-2013-06-30就诊、就诊年龄≥70岁,冠脉造影发现未处理3支病变,并在我院接受PCI治疗患者,记录基线数据,并根据血运重建方式分为完全血运重建(complete revascularization,CR)组68例与非完全血运重建(incomplete revascularization,IR)组251例,随访时详细记录患者主要心脑血管不良事件(MACCE)发生情况,采用单因素、多因素分析探究血运重建程度对患者远期预后影响。结果:平均随访(4.40±1.49)年,两组MACCE发生差异无统计学意义(IR组29.48%,CR组29.41%,P=0.9910)。CR组患者全因死亡率低于IR组(5.88%∶17.93%,P=0.0076),多因素分析显示完全血运重建是全因死亡的保护因素(HR=0.29,P=0.0204)。结论:老年冠心病3支病变患者PCI行完全血运重建预后较好。

Objective：To investigate the long-term prognoses of senior coronary three-vessel diseases patients undergoing complete or incomplete revascularization.Method：We enrolled patients who were not less than 70 years old on admission,from Jan 1st,2008 to June 30 th,2013,with untreated three-vessel CAD discovered by angiography and received treatment in our hospital.We collected their baseline date and assigned them to complete revascularization（CR）group or incomplete revascularization（IR）group.Major adverse cardiac and cerebrovascular events（MACCE）were recorded during follow-ups.Univariate and multivariate analyses were ran to figure out the potential divergence in prognoses.Result：We totally enrolled 319 patients,（IR251vs.CR 68）.The average follow-up period was 4.40±1.49 years and there was no statistical significance of the MACCE incidence between the two groups（IR 29.48%vs.CR 29.41%,P=0.9910）,while CR patients had a lower all-cause mortality（CR5.88% vs.IR 17.93%,P=0.0076）,which was reconfirmed in the multivariate analysis.Conclusion：Senior three-vessel CAD patients who undergo CR during PCI enjoy a better prognosis.