ACS患者PCI手术预后影响因素的多因素分析

A study on multivariate analysis of prognostic factors for patients with acute coronary syndromes after percutaneous coronary intervention

目的探讨影响急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）手术预后的相关影响因素。方法连续收集2008年1月至2010年12月在重庆市巴南区人民医院心内科成功行PCI手术的ACS患者114例，随访至2015年12月，分析患者的临床资料；运用Kaplan-Meier法计算ACS患者PCI术后生存率，采用Log—rank法比较PCI手术患者不同临床特征与预后之间的关系，并采用多因素Cox回归分析筛选影响患者预后的独立危险因素。结果全部患者随访11～57个月，中位随访时间26个月；随访期间21例（18．40／4）患者发生终点事件，其中一级终点事件死亡6例（5．3％），二级终点事件复发15例（13．2％）。患者术后生存时间4～57个月，平均生存时间44．5个月，1年、2年、3年生存率（OS）分别为85．4％、77．7％、72．6％。ACS患者PCI术预后的多因素分析显示，高血压、术后服用阿司匹林服药时间不足一年、术后服用氯吡格雷时间不足一年、术后未服用8_受体阻滞剂是影响PCI手术患者预后（发生终点事件）的独立危险因素（P〈0．05）。结论控制血压、加强PCI手术患者的长期药物治疗对ACS患者PCI术后的预后具有很重要的临床意义。

Objective To explore prognostic factors for patients with acute coronary syndromes after percutaneous coronary Intervention. Methods We retrospectively reviewed the ciinical data of 114 patients diagnosed with acute coronary syndromes and treated in People＇s hospital of Chongqing Banan during the period from January 2008 to December 2010 and follow-up their results of survival. Kaplan-Meier method was used to estimate survival rates, the association between the clinicopathologic characteristic and the prognosis in ACS patients was assessed using Log-rank test. Meanwhile Cox proportional hazards model was used to select independent risk factors of patientsr survival. Results The durations of follow-up ranged from 11-57 months,and the median fol- low-up time was 26 months. In the time of follow-up there were 21 deaths （18.4%） ,first end point event occurred 6 patients （5. 3%）, second endpoint events 15 cases （13.2%）. Survival time after operations was ranged from 4-57 months. The mean of the survival time were 44.5 months respectively. The one-year, two-year and three-year survival rates were 85.40%, 77.7% and 72.60%. Multivariate analysis showed that high blood pressure,lack of aspirin medication time a year,less than a year elopidogrel time, not taking β-bloekers affect the prognosis of patients undergoing PCI （endpoint events occurred） is an independent risk factor （P〈0.05）. Conclusion Control of blood pressure,strengthen the long-term drug therapy in patients undergoing PCI have very important clinical implications for prognosis in patients with ACS undergoing PCI.