影响冠心病患者经皮冠状动脉介入治疗术后死亡率的危险因素分析

Analysis on risk factors affecting the mortality of patients with coronary artery disease after undergoing percutaneous coronary intervention

目的分析影响经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后死亡的危险因素。方法选取2006年1月1日~2011年6月30日初次在北京大学人民医院、北京东直门中医院、沧州市中心医院和洛阳市中心医院4家医院接受PCI治疗并置入药物洗脱支架的冠心病患者为研究对象,对其术后死亡率以及影响死亡率的相关因素进行分析。结果共随访患者3 511人(85.4%),PCI术后死亡率是4.6%(161/3 511),多因素分析结果显示:年龄(HR=1.086,95%CI:1.059~1.113,P<0.001)、糖尿病(HR=1.807,95%CI:1.205~2.709,P=0.004)、吸烟(HR=1.873,95%CI:1.205~2.709,P=0.002)、贫血(HR=1.909,95%CI:1.266~2.879,P=0.002)、左心射血分数<50%(HR=2.546,95%CI:1.558~4.162,P<0.001)和双联抗血小板治疗(dual antiplatelet therapy,DAPT)时间<1年(HR=0.029,95%CI:0.013~0.067,P<0.001)与患者PCI术后死亡率相关。结论年龄、糖尿病、吸烟、贫血、心功能不良和DAPT时间<1年是影响冠心病患者PCI术后死亡率的危险因素,应该给予重视和合理干预。

Objective To discuss the risk factors of mortality after percutaneous coronary intervention （PCI） in patients with coronary heart disease. Methods A retrospective study was conducted among patients with coronary heart disease undergoing PCI with drug-eluting stents at four hospitals in China （Peking University Peopleg Hospital; Beijing U- niversity of Chinese Medicine Dongzhimen Hospital; Cangzhou Central Hospital, Hebei Province; Luoyang Central Hospital, Henan Province） from January 1st, 2006 to June 30th, 2011. Muhivariable cox proportional hazards models were used for analysis of mortality after PCI. Results 3 511 （ 85.4% ） patients finished follow-up and the mortality after PCI was 4.6% （161/3 511）. Age （HR=1.086, 95% CI：1.059-1.113, P〈0.001）, diabetes （HR=1.807, 95% CI：1.205- 2. 709, P = 0. 004 ） , smoking （ HR = 1. 873, 95% CI ： 1. 205-2. 709, P = 0. 002 ）, anemia （ HR = 1. 909, 95 % CI： 1. 266- 2. 879,P =0. 002）, left ventricular ejection fraction 〈 50% （HR = 2. 546, 95% CI： 1. 558-4. 162, P 〈 0. 001 ） and dual antiplatelet therapy （DAPT） time less than one year （ HR =0. 029, 95% CI：0. 013-0. 067, P 〈0. 001 ） were associated with increased all-cause mortality in patients undergoing PCI. Conclusions Age, diabetes, smoking, anemia, heart dys- function and DAPT time less than one year were risk factors of mortality after PCI and it should be taken into account seri- ously and intervened properly.