2013—2017年湖北省冠心病介入死亡病例特征分析

Characteristic analysis of interventional death cases of coronary heart disease in Hubei Province from 2013 to 2017

目的分析湖北省2013-2017年冠心病介入治疗死亡病例特点及其死亡相关危险因素,为冠心病介入治疗安全性提供资料。方法应用湖北省心血管疾病介入诊疗管理信息网数据,统计并分析2013-2017年湖北省冠心病介入治疗死亡率变化趋势及危险因素。结果2013-2017年,湖北省冠心病介入量持续上升,死亡率维持在0.069%～0. 172%。与存活组比较,死亡组的女性比例较高、平均年龄较大、STEMI和不稳定型心绞痛比例较高、既往高血压史较少、心力衰竭史较多,差异均有统计学意义(χ~2/P=5. 401/0. 025、353. 165/<0. 001、135. 826/<0. 001、14. 132/<0.001、31.766/<0.001);介入诊疗情况中,死亡组血管病变为三支病变、左主干(LM)病变,病变血管完全闭塞,血栓病变、完全闭塞型病变及长病变>20 mm,术前TIMI血流0级,术后TIMI血流0级,行主动脉内球囊反搏等比例均较存活组高,差异均有统计学意义(χ~2/P=17. 264/<0.001、88. 015/<0. 001、117. 435/<0. 001、54.370/<0.001、55.198/<0.001、28.101/<0.001、131.613/<0.001、11.429/0. 005、1 407.080/<0.001)。另外,死亡率在年PCI量不同医院间存在统计学差异(P <0. 001)。Logistic分析显示STEMI(OR=7.988,95%CI 2.617～24. 386,P <0.01)、三支病变+LM病变(OR=9.786,95%CI 1.726～55. 482,P <0.05)、行急诊PCI(OR=2. 719,95%CI 1.116～6.628,P<0.05)、术后TIMI血流1级(OR=17.267,95%CI 2.885～103.340,P<0.01)、术后TIMI血流2级(OR=12. 935,95%CI 1. 150～145.441,P <0.05)及行主动脉内球囊反搏(OR=16. 972,95%CI 1.730～166. 481,P <0.05)为患者院内死亡的高危因素。结论2013-2017年湖北地区冠心病介入手术院内死亡率维持在较低水平,STEMI、多支病变、行急诊PCI、主动脉内球囊反搏及术后TIMI血流1级和2级是介入死亡的危险因素。

Objective To analyze the characteristics of death cases and risk factors related to death in interventional therapy of coronary heart disease in Hubei Province from 2013 to 2017, and to provide information for the safety of interventional therapy of coronary heart disease. Methods Based on the data of Hubei Interventional Diagnosis and Treatment Management Information Network for Cardiovascular Diseases, the mortality trend and risk factors of coronary heart disease in Hubei Province from 2013 to 2017 were analyzed. Results From 2013 to 2017, the intervention volume of coronary heart disease in Hubei Province continued to rise, and the mortality rate remained between 0.069% and 0.172%. Compared with the survival group, the death group had higher proportion of women, higher average age, higher proportion of STEMI and unstable angina pectoris, fewer history of hypertension and more history of heart failure (χ^2/ P =5.401/0.025,χ^2/ P =353.165/< 0.001 ,χ^2/ P =135.826/<0.001,χ^2/ P =14.132/<0.001,χ^2/ P =31.766/<0.001). There were three vessel lesions, left main artery (LM) lesions, complete occlusion of vessels, thrombosis, complete occlusion and long lesion >20 mm, preoperative TIMI blood flow grade 0, postoperative TIMI blood flow grade 0, intra-aortic balloon counterpulsation and other proportions were higher than those of survival group, the differences were statistically significant (χ^2/ P =17.264/<0.001,χ^2/ P =88.015/<0.001,χ^2/ P =117.435/<0.001,χ^2/ P =54.370/<0.001,χ^2/ P =55.198/<0.001,χ^ 2/ P =28.101/<0.001,χ^2/ P =131.613/<0.001,χ^2/ P =11.429/0.005,χ^2/ P =1 407.080/<0.001). In addition, there were statistical differences in mortality among hospitals with different annual PCI volume ( P <0.001). Logistic analysis showed STEMI ( OR =7.988,95% CI 2.617-24.386, P <0.01), three-vessel lesions+LM lesions ( OR =9.786,95% CI 1.726-55.482, P <0.05), emergency PCI ( OR =2.719, 95% CI 1.116-6.628, P <0.05), postoperative TIMI blood flow grade 1 ( OR =17.267,95% CI 2.885-103.340, P <0.01), postoperative TIMI grade 2 ( OR =12.935, 95% CI 1.150-145.441, P <0.05) and intra-aortic balloon counterpulsation ( OR =16.972, 95% CI 1.730-166.481, P <0.05) were the high risk factors for hospital mortality. Conclusion From 2013 to 2017, the hospital mortality rate of coronary artery disease interventional surgery in Hubei province remained at a low level. STEMI, multi-vessel lesions, emergency PCI, intra-aortic balloon counterpulsation and TIMI blood flow levels 1 and 2 were risk factors for interventional death.