冠心病家族史阳性患者1072例PCI预后分析

Prognostic analysis of 1072 patients with positive family history of coronary heart disease after PCI

目的分析冠状动脉粥样硬化性心脏病(CHD)家族史阳性患者经皮冠状动脉介入治疗(PCI)的预后。方法选取在医院行PCI术且伴CHD家族史患者1072例为阳性组,随机抽取同期行PCI术且CHD家族史阴性患者1000例为阴性组。收集基线资料包括年龄、性别、体质指数(BMI)和冠心病危险因素(吸烟、糖尿病、高血压、高脂血症)。平均随访时间1~120(59.0±23.7)月,随访终点为心源性死亡和全因死亡事件。通过Kaplan-Meier法记录生存曲线,通过COX多因素回归法分析影响预后的独立预测因素。结果 CHD家族史阳性组患者的BMI、糖尿病和高血压病的发病率与阴性组无显著差异(P>0.05);发病年龄、吸烟率显著低于阴性组,而男性比例、高脂血症发病率显著高于阴性组,差异均有统计学意义(P<0.05)。COX多因素回归分析显示:CHD家族史和他汀类药物是PCI患者心源性死亡和全因死亡事件的独立保护因素,而高龄是全因死亡的独立危险因素。Kaplan-Meier生存曲线示CHD家族史阳性组患者PCI全因死亡生存率和心源性死亡生存率均显著高于阴性组患者。结论阳性CHD家族史是患者PCI预后的独立保护性因素,这类患者PCI术后预后优于阴性者。

Objective To analyze the prognosis of patients with positive coronary heart disease（ CHD） family history（ FH） after percutaneous coronary intervention（ PCI）. Methods 1072 patients with positive FH of CHD who underwent PCI in the hospital was selected as positive group,randomly selected 1000 patients with negative FH of CHD who underwent PCI from the same period as negative group. Baseline data include age,gender,body mass index（ BMI） and coronary heart disease risk factors（ smoking,diabetes,hypertension,hyperlipidemia）. Mean follow-up time was 1 - 120（ 59. 0 ± 23. 7） months,and the end point was cardiac death and death. The independent prognostic factors was assessed by Cox multivariate regression models,the survival rate was assessed by Kaplan-Meier survival curves. Results Patients in positive group and negative group had no difference in BMI and the incidence of diabetes,hypertension（ P〉0. 05）; age of onset,smoking rate were significantly lower than that of the negative group（ P〈0. 05）; the proportion of men and the incidence of hyperlipidemia were significantly greater than negative group（ P〈0. 05）. Cox multivariate regression analysis： FH of CHD and application of statins were the protective factors of death in patients after PCI operation,and the age was the risk factor of that. FH of CHD and application of statins were the protective factors of cardiac death in patients after PCI operation. Kaplan-Meier survival curves analysis suggested that the survival rate and survival rate of cardiac death in patients with CHD were significantly higher than those in the negative group after PCI. Conclusion Positive FH of CHD is an independent protective factor for the prognosis of patients with PCI.The prognosis of the patients with positive FH of CHD who underwent PCI was better than negative ones.