合并多血管疾病冠心病患者经皮冠状动脉介入治疗长期预后的研究

Impact of Poly-vascular Disease on Long-term Outcome of Coronary Artery Disease Patients Post Percutaneous Coronary Intervention

目的:探讨合并多血管疾病对经皮冠状动脉介入治疗(PCI)后冠心病患者长期预后的影响。方法:连续纳入2013年1月至12月于中国医学科学院阜外医院行PCI的冠心病患者10 287例。多血管疾病定义为冠心病患者既往合并缺血性脑卒中和(或)外周动脉疾病。根据患者是否合并多血管疾病分为两组:多血管病组(n=1 583)和非多血管病组(n=8 704)。比较两组患者随访期间主要不良心脑血管事件(MACCE),及全因死亡、心肌梗死、再次血运重建、新发脑卒中和支架内血栓形成的发生率。MACCE为全因死亡、心肌梗死、再次血运重建和新发脑卒中的复合终点。结果:1 583例(15.4%)患者合并多血管疾病。与非多血管病组患者相比,多血管病组患者老年及女性比例高,危险因素及合并症更常见,冠状动脉病变也更加复杂,差异均有统计学意义(P均<0.05)。在中位随访29(1~34)个月期间,多血管病组患者MACCE(15.0%vs 11.6%,P=0.004)、全因死亡(2.5%vs 1.2%,P=0.018)、新发脑卒中(3.2%vs 1.4%,P=0.000)和支架内血栓形成(1.8%vs 0.8%,P=0.014)的发生率均高于非多血管病组患者,差异均有统计学意义。多因素Cox分析显示,合并多血管病是PCI后MACCE发生的独立危险因素(OR=1.230,95%CI:1.067~1.418,P=0.004)。另外,在多血管病组患者中,完全血运重建的患者较非完全血运重建的患者MACCE发生率低(13.1%vs 16.5%,P=0.045)。结论:合并多血管疾病的冠心病患者PCI后远期预后较差,其中冠状动脉完全血运重建患者可能受益更多。

Objectives:The purpose of our study was to investigate the impact of poly vascular disease(PVD)on long-term outcomes in coronary artery disease(CAD)patients undergoing percutaneous coronary intervention(PCI).Methods:A total of 10 287 consecutive patients underwent PCI in Beijing Fuwai Hospital from January 2013 to December 2013 were enrolled.According to the history of PVD,patients were classified into two groups:PVD group(n=1 583)and no PVD group(n=8 704).The major adverse cardiovascular and cerebrovascular events(MACCE),all-cause death,myocardial infarction(MI),target vessel revascularization(TVR),stroke and stent thrombosis(ST)during follow-up were compared between the two groups.Results:Patients with PVD were older and percent of female was higher.Risk factors,comorbidities and complex coronary lesions were also more common in PVD group.During a median follow-up of 29 months,patients in PVD group faced a higher risk of MACCE(15.0%vs 11.6%,P=0.004),all-cause death(2.5%vs 1.2%,P=0.018),stroke(3.2%vs 1.4%,P=0.000)and ST(1.8%vs 0.8%,P=0.014).Cox regression analysis demonstrated that PVD was independently associated with a higher risk of MACCE(adjusted HR=1.230,95%CI:1.067-1.418,P=0.004).Conclusions:Patients with PVD is associated with substantial higher risk of MACCE following PCI procedure.Concerns should thus be raised and active treatment strategies are needed for CAD patientswith PVD undergoing PCI.