有无心脏外科支持的经皮冠状动脉介入术病例特点及转归的比较分析

Comparative Analysis of the Characteristics and Outcome of Patients Underwent PCI with or without Cardiac Surgery Support

目的:分析有无心脏外科支持的经皮冠状动脉介入术(PCI)病例的特点及转归差异。方法:回顾性分析2308例行PCI术患者的病例资料,根据心脏外科支持情况分为支持组(2031例)、无支持组(277例),比较两组患者的基线资料、PCI术相关指标及主要不良心血管事件(MACE)的发生情况。结果:与支持组比较,无支持组患者的医疗费用明显增加,急诊PCI、危险因素中AMI病史、PCI史、疾病诊断中STEMI的比例明显降低,LVEF明显升高,差异均有统计学意义(P<0.05)。支持组以三支及以上冠脉病变以及B、C型复杂病变形态多见,支架置入数、左主干病变比例明显增多,靶血管IVUS比例检查比例、术中总并发症发生率明显降低,与无支持组比较差异均有统计学意义(P<0.05)。两组PCI术后MACE的发生率比较差异均无统计学意义(P>0.05)。结论:有无心脏外科支持的PCI患者的临床特点存在较大差异,无心脏外科支持的PCI患者以急诊手术为主,且靶血管病变相对较轻。对于低风险病例实施PCI手术是安全可行的,具有较高成功率,预后尚可。

Objective： To investigate the clinical characteristics and prognosis between patients underwent percutaneous coronary intervention（PCI） with or without cardiac surgery support. Methods： The clinical data of 2308 cases of patients underwent PCI were retrospectively analyzed, they were divided into the backup group（n=2031） and the non-backup group（n=277） according to the cardiac surgery support. The baseline information, PCI related indicators, and occurrence of major adverse cardiac events（MACE） in two groups were compared. Results： Compared with the backup group, there were significant increase in the medical costs and LVEF, decrease in the percentage of emergency PCI, history of AMI and PCI, STEMI in the non-backup group（P〈0.05）. Backup group was given priority to triple-vessel disease and over, complex lesions of type B and C, numbers of stent placement and the proportion of left main lesion were significantly increased, and the proportion of target vessel intravascular ultrasound（IVUS）, the success rate of PCI, total incidence of intraoperative complications were significantly lower than those in the non-backup group（P〈0.05）. There was no significant difference in the incidence of MACE after PCI between two groups（P〈0.05）. Conclusions： There is remarkable difference in the clinical characteristics in PCI between with or without cardiac surgery, PCI without cardiac surgery is given priority to emergency PCI with relatively milder lession of target vessel. PCI is safe and feasible for low risk cases, and has high success rate and fair prognosis.