类风湿关节炎合并冠心病患者的冠状动脉病变特点及院内不良事件分析

Coronary angiographic features and in-hospital outcome of patients with coronary artery disease and rheumatoid arthritis

目的总结合并类风湿关节炎(RA)的冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉病变特点以及接受经皮冠状动脉介入治疗(PCI)术后的院内不良事件发生情况。方法收集2009年1月至2017年6月在首都医科大学附属北京友谊医院接受PCI的69例RA患者的临床资料,回顾性分析RA患者的临床表现、冠状动脉病变特点及住院期间主要不良事件发生情况。结果69例患者中男性11例(15.9%),平均年龄(67.2±13.0)岁,平均SYNTAX评分(31.6±7.2)分。55例(79.7%)患者冠心病传统危险因素≥1个,51例(73.9%)患者为冠状动脉多支血管病变。69例患者共置入145枚支架,其中裸金属支架2枚和药物洗脱支架143枚,50例(72.4%)患者置入了长支架(支架长度>30 mm)。住院期间共25例(36.2%)患者发生主要不良事件,包括心源性死亡1例(1.4%)、支架内血栓2例(2.9%)、PCI相关心肌梗死5例(7.2%)、急性左心衰竭5例(7.2%)、消化道出血4例(5.8%)、对比剂肾病10例(14.5%,包括2例急性左心衰竭患者)。结论合并RA的冠心病患者冠状动脉病变以多支复杂病变为主,此类患者接受PCI后院内不良事件发生率较高,围术期应做到早识别、早预防。

Objective To report the coronary angiographic features and in-hospital outcome in coronary artery disease（CAD） patients with rheumatoid arthritis（RA） who underwent percutaneous coronary intervention（PCI） with stent implantation. Methods The study group comprised 69 consecutive patients with RA who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2017. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse events in hospital. Results Fifty five patients（79.7%） had one or more traditional CAD risk factors. Multivessel disease was present in 73.9% of the patients, and the average SYNTAX score was（31.6±7.2）. Two bare metal stents and 143 drug eluting stents were implanted. 50 cases（72.4%） required implantation of long stents（stent length 30 mm）.There were 25 patients developed major adverse events（36.2%） during hospitalization, including 1 case of cardiac death, 2 cases of stent thrombosis, 5 cases of PCI related MI, 5 cases of heart failure, 5 cases of gastrointestinal bleeding and 10 cases of contrast induced nephropathy（2 cases comorbided acute heart failure）. Conclusions Patients with RA and CAD may have severe coronary lesions.PCI in these patients tends to result in an increased rate of major adverse events in-hospital.Hence there is a need of early identification and early prevention in these patients during perioperative period.