老年冠心病患者PCI围术期出血与术后1年主要不良心血管事件的相关性

Correlation between perioperative hemorrhage and major adverse cardiovascular events in elderly patients with coronary heart disease one year after PCI

目的探讨老年冠心病患者经皮冠状动脉介入(PCI)围术期出血与术后1年主要不良心血管事件的相关性。方法选取2013年1月至2014年12月榆林市中医院及西安交大第一附属医院心血管内科收治的老年冠心病并行PCI手术的患者570例,根据患者围术期有无出血将患者分为围术期出血组(82例)及未出血组(488例),对比两组患者一般资料、PCI指标及术后1年不良心血管事件发生情况,采用Cox比例风险回归分析PCI围术期出血与术后1年主要不良心血管事件的关系。结果与未出血组相比,围术期出血组患者年龄较大,体质量指数(BMI)≤20kg/m2、20~25kg/m^2比例较高,术前诊断不稳定型心绞痛比例较低,ST段抬高型心肌梗死(STEMI)比例较高,血红蛋白(Hb)、血细胞比容、左室射血分数(LVEF)、肌酐清除率较低,PCI途径经桡动脉比例较低,应用血管内超声、应用主动脉内球囊反搏比例较高,出院带药阿司匹林比例较低,西洛他唑比例较高,差异均有统计学意义(P均<0.05)。围术期出血组患者术后1年心脏源性死亡、死亡总数、心肌梗死与死亡发生率较未出血组高,差异均有统计学意义(P均<0.05)。Cox比例风险回归分析发现,围术期2级及以上出血是术后1年主要不良心血管事件的独立预测因素(HR=2.394,95%CI=1.259~4.553,P=0.008)。结论老年冠心病患者PCI围手术期出血与术后1年主要不良心血管事件相关,PCI围术期2级及以上出血是术后1年不良主要心血管事件的独立危险因素。

Objective To explore the correlation between perioperative hemorrhage and major adverse cardiovascular events in elder-ly patients with coronary heart disease one year after PCI. Methods 570 patients with coronary heart disease underwent PCI from January 2013 to December 2014 in our hospital were divided into perioperative hemorrhage group （82 cases） and non-hemorrhage group （488 ca-ses） according to patients with or without perioperative hemorrhage. General information, PCI indicators and adverse cardiovascular events 1 year after PCI of patients in two groups were compared. Cox proportional hazard regression analysis was used to analyze the relationship be-tween perioperative hemorrhage and major adverse cardiovascular events during 1 year after PCI. Results Compared to non-hemorrhage group, patients in perioperative hemorrhage group had older age, higher proportion of BMI≤20, 20~25, lower proportion of preoperative di-agnosis of unstable angina pectoris and higher proportion of ST segment elevation myocardial infarction （ STEMI） , lower hemoglobin （ Hb） , hematocrit, left ventricular ejection fraction （ LVEF） and creatinine clearance rate, lower proportion of transradial approach, higher propor-tion of application of intravascular ultrasound and intra-aortic balloon pump, lower proportion of aspirin and higher proportion of cilostazol （ P〈0. 05）. Compared to non-hemorrhage group, patients in perioperative hemorrhage group had higher rate of cardiac death, death, myo-cardial infarction and death 1 year after PCI （P〈0. 05）. Cox proportional hazard regression analysis showed that the perioperative period of 2 and above hemorrhage was the independent predictors of major adverse cardiovascular events during the 1 year after PCI （ HR=2. 394, 95%CI=1. 259~4. 553, P=0. 008）. Conclusion Perioperative hemorrhage of grade 2 and above in PCI is an independent risk factor for adverse cardiovascular events in 1 year after operation.