老年冠心病患者药物洗脱支架置入术后临床结局分析

Clinical outcome in elderly CHD patients after implantation of drug-eluting stents

目的探讨经皮冠状动脉介入治疗范围、复杂性和血小板反应性对药物洗脱支架置入术后老年冠心病患者临床结局的影响。方法选择2014年1月~2017年1月彭州市人民医院心内科收治的行药物洗脱支架置入术的老年冠心病患者150例,术后给予三联抗血小板治疗18个月,随访2年,根据2年内是否发生不良心血管事件分为预后不良组43例和预后良好组107例。观察2组临床特征、经皮冠状动脉介入治疗范围、复杂性、血小板反应性和心功能指标。采用多因素logistics回归分析药物洗脱支架置入术后老年冠心病患者发生不良心血管事件的危险因素。结果与预后良好组比较,预后不良组病变支数、支架数量、支架总长度、Gensini评分和血小板聚集率明显增加(P<0.01)。与预后良好组比较,预后不良组平均室壁应力、左心室舒张末期容积明显增加[(974.75±94.65)mg vs (921.92±89.86)mg,P=0.002;(158.88±14.43)ml vs (151.73±13.87)ml,P=0.005]。多因素logistics回归分析显示,血小板聚集率、病变支数、支架数量、支架总长度、Gensini评分和左心室舒张末期容积是药物洗脱支架置入术后老年冠心病患者发生不良心血管事件的危险因素(P<0.05)。结论冠状动脉病变复杂、治疗范围广、血小板抵抗和心功能下降是药物洗脱支架置入术后老年冠心病患者发生不良心血管事件的危险因素。

Objective To study the effect of PCI parameters and platelet reactivity on clinical outcome in elderly CHD patients after implantation of drug-eluting stents.Methods One hundred and fifty elderly CHD patients were divided into poor outcome group (n=43) and good outcome group (n=107) according to the adverse cardiovascular events occurred during the 2-year followup period after 18-month triple antiplatelet therapy.Their clinical characteristics, cardiac function, PCI parameters and platelet reactivity were recorded.The risk factors for adverse cardiovascular events in elderly CHD patients after implantation of drug-eluting stents were analyzed by multivariate logistic regression analysis. Results The number of infarcted branches and implanted stents was significantly greater,the total length of stents was significantly longer,the Gensini score and platelet aggregation rate were significantly higher in poor outcome group than in good outcome group (P<0.01). The average ventricular wall stress was significantly higher and the left ventricular end diastolic volume was significantly larger in poor outcome group than in good outcome group (P<0.01). Multivariate logistic regression analysis showed that platelet aggregation rate,number of infarcted branches and stents, total length of stents, Gensini score and left ventricular end diastolic volume were the risk factors for adverse cardiovascular events in elderly CHD patients after implantation of drug-eluting stents (P<0.05).Conclusion Coronary artery lesions,PCI parameters, platelet resistance and decreased cardiac function are the risk factors of adverse cardiovascular events in elderly CHD patients after implantation of drug-eluting stents.