北京市高同型半胱氨酸血症伴低CHA2DS2-VASc非瓣膜性心房颤动PCI患者的预后分析

Prognosis of non-valvular atrial fibrillation patients after PCI with hyperhomocysteinemia and low CHA2DS2-VASc in Beijing

目的分析北京市高同型半胱氨酸血症(HHcy)伴CHA2DS2-VASc≤1的非瓣膜性心房颤动(NVAF)-经皮冠状动脉介入(PCI)患者的预后。方法选择CHA2DS2-VASc=0或1的NVAF-PCI患者共1688例,评估其主要不良心血管事件的风险及影响因素。依据入院时同型半胱氨酸水平分为对照组(n=1135,Hcy<15μmol/L)和HHcy组(n=553,Hcy≥15μmol/L)。主要终点是MACE事件的发生。结果随访1年,HHcy组MACE事件发生率较高(P=0.017),HHcy组缺血性卒中的发生率明显高于对照组(P=0.009),两组心因死亡(P=0.046)及非致死性心肌梗死(P=0.044)的发生率差异有显著性。结论HHcy增加CHA2DS2-VASc≤1 NVAF-PCI患者的MACE事件尤其是缺血性卒中的发生,提示这类患者接受抗凝治疗可能临床获益较大。

Aim To analyse the prognosis of non-valvular atrial fibrillation patients after PCI with hyperhomocysteinemia and CHA2 DS2-VASc in Beijing.Methods A total of 1688 NVAF-PCI patients with CHA2 DS2-VASc=0 or 1 was selected to evaluate the risk and influencing factors of major adverse cardiac events(MACE)within 1 year.Patients were divided into two groups according to their plasma homocysteine(Hcy)levels before catheterization:the normal group(1135 patients,Hcy<15μmol/L)and the HHcy group(553 patients,Hcy≥15μmol/L).The primary endpoint was the occurrence of MACE.Results After 1 year of follow-up,HHcy patients had a higher rate of MACE(P=0.017).The main differences between the two groups were ischemic stroke(P=0.009),cardiac death(P=0.046)and non-fatal myocardial infarction(MI)(P=0.044).Conclusion Elevated Hcy levels were independently associated with an increased risk of MACE in non-valvular AF patients with low CHA2 DS2-VASc scores after coronary artery stent implantation,and to receive anticoagulant may be effective.