稳定性冠心病患者ABO血型与经皮冠状动脉介入治疗远期预后的相关性

Effect of ABO blood groups on long-term outcome of stable coronary artery disease after percutaneous coronary intervention

目的研究评估ABO血型与行经皮冠状动脉介入(PCI)治疗的稳定性冠心病(SCAD)患者长期预后的相关性。方法连续纳入自2013年1至12月于中国医学科学院阜外医院行PCI治疗的4 272例稳定性冠心病患者,根据ABO血型,分为O型组(例)和非O型组(例),并随访2年。主要终点为心源性死亡、死亡、心肌梗死(MI)、血运重建(靶血管或靶病变血运重建)和脑卒中。采用多因素COX回归分析O型组和非O型组与长期预后的相关性。结果本研究中,O型组患者1 302例,非O型组患者2 970例。ABO血型分布与年龄、性别、血压无明显相关(P>0.05)。O型血与非O型血相比,合并高血压、糖尿病、吸烟、冠心病家族史、既往心肌梗死、既往脑血管病变、既往PCI的比例及左室射血分数差异无统计学意义(P>0.05)。非O血型组中,总胆固醇、低密度脂蛋白胆固醇水平显著高于O血型组[(4.2±1.1)mmol/L比(4.1±1.1)mmol/L,P=0.027;(2.5±0.9)mmol/L比(2.4±0.9)mmol/L,P=0.025],同时,高密度脂蛋白胆固醇水平显著低于O血型组[(1.04±0.26)比(1.06±0.28)mmol/L,P=0.035]。根据冠状动脉造影结果,两组间左主干+三支病变的患者比例差异无统计学意义(P=0.739)。非O血型组的SYNTAX评分略高于O血型组,但该差别未达统计学差异(P=0.277)。两组间术后无再流发生的比例差异无统计学意义(P=0.675)。与O血型组相比,非O血型组心源性死亡的发生率明显升高(0.7%比0.1%,P=0.023)。但经校正混杂因素后,COX回归分析表明,非O血型与心源性死亡不再显著相关[HR(95%CI)=7.30(0.97~55.09),P=0.054]。结论在接受PCI治疗的稳定性冠心病患者中,非O血型与心源性死亡相关,但不是心源性死亡的独立危险因素。

Objective To evaluate the effect of ABO blood groups on long-term outcome of stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Methods A total of 4 272 patients with stable coronary artery disease and received PCI were consecutively enrolled from January to December 2013 and followed up for 2 years. Patients were divided into O group and non-O group according to their ABO groups. Multivariable COX regression was used to evaluated the relationship between ABO blood groups and prognosis of CAD. The endpoints included all-cause death, cardiac death, myocardial infarction(MI), revascularization, and stroke. Results There were 1 302 patients in O group and 2 970 patients in non-O group. ABO blood group was not associated with age, sex and blood pressure (P>0.05). The comorbidity rate of hypertension, diabetes mellitus, smoking, family history, previous MI, previous cerebrovascular disease, previous PCI and left ventricular ejection fraction were similar between the two groups (P>0.05). Total cholesterol, low density lipid cholesterol level were significantly higher in non-O group compared with O group [(4.2±1.1)mmol/L vs (4.1±1.1)mmol/L, P=0.027;(2.5±0.9)mmol/L vs (2.4±0.9) mmol/L, P=0.025], while high density lipid cholesterol level was significantly lower[(1.04±0.26) mmol/L vs (1.06±0.28) mmol/L, P=0.035]. As to angiographic results, non-O blood group was not related to the severity of coronary atherosclerosis assessed by SYNTAX score(P=0.277). More cardiac death occurred in non-O group compared with that in O group [21 (0.7%) vs 2(0.1%)] during 2-year follow-up. After adjusted for confounding factors, multivariable COX regression revealed that non-O blood type was not associated with increased cardiac death [HR (95%CI)=7.30(0.97-55.09), P=0.054]. Conclusion Non-O blood group is associated with 2-year cardiac death in patients with stable coronary artery disease who received PCI, but it is not an independent risk factor for cardiac death.