入院超敏C反应蛋白对急性冠状动脉综合征行药物洗脱支架置入患者预后的影响

Impact of high-sensitivity C-reactive protein on outcomes in patients with acute coronary syndrome mdergoing drug-eluting stent implantation

目的探讨入院超敏C反应蛋白（hs－CRP）水平对非ST段抬高型急性冠状动脉综合征（NSTE－ACS）置入药物洗脱支架患者远期预后的影响。方法连续纳入自2013年1至12月于阜外医院置入药物洗脱支架的非ST段抬高型急性冠状动脉综合征（NSTE－ACS）患者4 815例，根据入院hs－CRP水平将患者分为低危（〈1.00 mg/L）、中危（1.00～2.99 mg/L）和高危组（≥3.00 mg/L），比较3组患者2年内主要不良心脑血管事件（MACCE，包括死亡、心肌梗死、支架内血栓、血运重建和脑卒中）差异，利用Kaplan－Meier生存曲线和多因素Cox回归分析随访结果和预后不良的独立危险因素。结果术前hs－CRP水平高的患者有更多心脑血管病的危险因素，如合并症（高血压、既往介入手术和脑血管疾病史）多，多支病变比例（68.5%比73.6%比76.2%，P〈0.001）更高。三组患者2年MACCE的发生率分别为8.8%、11.2%和12.6%（P＝0.003），血运重建比例为6.5%、8.5%和9.8%（P＝0.003），但全因死亡、心肌梗死、支架内血栓和卒中的发生率比较差异均无统计学意义（均P〉0.05）。Kaplan－Meier生存曲线表明，随时间推移，主要复合终点和血运重建的累积事件率在三组整体间比较差异有统计学意义（Log－rank检验均P〈0.01）。多因素Cox回归显示，hs－CRP≥3.00 mg/L是MACCE的独立危险因素，其发生MACCE的风险是hs－CRP 〈1.00 mg/L的1.42倍（95%CI 1.13～1.78, P＝0.002）。多支病变、射血分数〈50%和白细胞升高也是MACCE的独立预测因子。CRP≥3.00 mg/L（与〈1.00 mg/L比较，HR 1.56, 95%CI 1.16～2.08, P＝0.003）和多支病变是再次血运重建的独立预测因子。结论（1）NSTE－ACS患者入院hs－CRP水平升高者常伴随更多高危临床因素；（2）hs－CRP更高的患者2年主要不良心脑血管事件和血运重建的发生风险明显增加；（3）入院hs－CRP是NSTE－ACS置入DES患者远期预后的独立危险因素。

ObjectiveTo investigate the association between high-sensitivity C-reactive protein （hs-CRP） and long-term outcomes in Chinese patients with non-ST-segment elevation acute coronary syndrome （NSTE-ACS） after drug-eluting stent （DES） implantation.MethodsA total of 4 815 consecutive NSTE-ACS patients who treated with DESs were included.Patients were divided into three groups： 〈1.00 mg/L, 1.00 to 2.99 mg/L and ≥3.00 mg/L, based on the level of hs-CRP on admission.Major adverse cardiovascular and cerebrovascular events （MACCE, including all-cause death, myocardial infarction, revascularization, in-stent thrombosis and stroke） were compared among groups during 2-year follow-up.ResultsPatients with higher hs-CRP had more risk factors of cardiovascular events such as concomitant morbidities and multi-vessel lesions（68.5% vs 73.6% vs 76.2%, P〈0.001）. Higher hs-CRP value was associated with increased rates of MACCE （8.8% vs 11.2% vs 12.6%, P=0.003） and revascularization （6.5% vs 8.5% vs 9.8%, P=0.003）. However, the rates of all-cause death, myocardial infarction, stroke, and stent thrombosis were comparable among groups（all P〉0.05）. Ongoing divergences in MACCE and revascularization among three groups were significant on Kaplan-Meier curves （both Log-rank P=0.003）. Multivariable Cox regression analysis indicated that compared to hs-CRP〈1.00 mg/L group, MACCE in the 〉3.00 mg/L group was increased by 42% [HR 1.42 （1.13-1.78）, P=0.002]. Meanwhile, multivessel leisions, ejection fraction〈50%, elevated white blood cell counts were also independent risk factors.CRP≥3.00 mg/L（HR 1.56, 95%CI 1.16-2.08, P=0.003, compared to 〈1.00 mg/L） and multivessel leisions were independent predictors of revascularization.Conclusions（1）Patients with higher hs-CRP on admission have more risk factors of cardiovascular events.（2）Higher hs-CRP value is associated with increased rates of MACCE and revascularization.（3）Pre-procedural hs-CRP is an independent predictor of 2-year outcomes for Chinese NSTE-ACS patients treated with DESs.