代谢综合征及其组分对冠状动脉介入术患者远期预后的影响

The impact of metabolic syndrome and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention

目的探讨代谢综合征(MS)及其组分对行经皮冠状动脉介入术(PCI)患者临床远期预后的影响。方法纳入2013年在阜外医院行PCI治疗的患者。根据有无MS分为两组:无MS组和有MS组。2年随访的主要终点为主要不良心血管事件(MACE),包括死亡、心肌梗死和血运重建。结果在10422例PCI患者中,无MS组5656例(54.27%),有MS组4766例(45.73%)。MS组患者年龄更小、男性占比更多,合并症更多,两组在药物涂层支架的应用比例和介入治疗的成功率方面比较差异均无统计学意义。2年随访显示:MS组的MACE发生率显著高于无MS组(12.0%比10.0%,P<0.001),这主要是由于MS组的再次血运重建比例显著高于无MS组(9.5%比7.9%,P=0.003)所致。COX分析显示:MS是MACE的独立危险因素,MS组分分析中:糖代谢异常是MACE事件的独立危险因素。结论(1)行PCI术患者中,有MS者在2年随访期MACE发生率显著高于无MS者,且MS是MACE的独立危险因素;(2)在MS组分中,高血糖是MACE的独立危险因素。

Objective To investigate the impact of metabolic syndrome(MS)and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention(PCI).Methods Patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided to two groups:with MS and without MS.The primary endpoint of 2-year follow-up was major adverse cardiovascular events(MACE),including death,myocardial infarction,and repeat revascularization.Results Of the 10422 PCI patients,there were 5656(54.27%)without MS and 4766(45.73%)with MS.Patients in the MS group were younger,tended to be male and had more comorbidities.There were no significant differences between the two groups in the proportion of drug-coated stents and the success rate of interventional therapy.The 2-year follow-up showed that the incidence of MACE in the MS group was significantly higher than that in the MS-free group(12.0%vs 10.0%,P<0.001),which was mainly due to the significantly higher revascularization rate in the MS group than in the non-MS group(9.5%vs 7.9%,P=0.003).Cox's regression analysis showed that MS was an independent risk factor for MACE.In MS component analysis,abnormal glucose metabolism was an independent risk factor for MACE events.Conclusions Among the patients undergoing PCI,the incidence of MACE in patients with MS is significantly higher than that in patients without MS,and MS was an independent risk factor for MACE.In addition,hyperglycemia is an independent predictor for MACE.