急性冠状动脉综合征合并恶性肿瘤患者经皮冠状动脉介入术后长期预后分析

Long-Term Prognosis of Patients with Acute Coronary Syndrome Compli-cated with Malignant Tumor after Percutaneous Coronary Intervention

目的:探讨行经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)的急性冠状动脉综合征(acute coronary syndromes, ACS)合并恶性肿瘤患者的远期预后。方法:回顾性选择2014年1月至2017年12月于临沂市人民医院心内科行PCI治疗的ACS合并恶性肿瘤患者78例,按照1∶2的比例选择同期行PCI治疗但未合并恶性肿瘤的ACS患者156例为对照组,收集2组患者的一般人口学、既往疾病史(包括恶性肿瘤相关病史)、药物及PCI治疗情况、临床及心脏超声检查情况和心血管相关危险因素等,所有患者随访至2020年6月,比较2组治疗结果及预后情况。结果:ACS合并恶性肿瘤组患者的平均年龄高于ACS未合并恶性肿瘤组,差异有统计学意义(P<0.05)。2组患者的临床及心脏超声检查情况、药物治疗情况之间差异均无统计学意义(均P>0.05)。ACS合并恶性肿瘤组患者的冠状动脉特殊病变中钙化病变的比例明显高于ACS未合并恶性肿瘤组,而CTO病变的比例则低于未合并恶性肿瘤组,差异均有统计学意义(均P<0.05);而2组患者的ACS类型、病变血管数量、置入支架数量和其他冠状动脉特殊病变比例之间差异均无统计学意义(均P>0.05)。ACS合并恶性肿瘤组患者的心血管死亡率明显高于未合并恶性肿瘤组,差异均有统计学意义(P<0.05);2组患者次要终点事情除肿瘤死亡率存在差异外,其余全因死亡、心源性休克、心血管原因再入院和再次PCI、再次冠状动脉旁路移植术等远期随访事件发生率之间均无统计学差异(均P>0.05)。结论:合并恶性肿瘤行PCI治疗的ACS患者的远期心血管不良结局的发生率较高,提示对于ACS合并恶性肿瘤人群应密切随访、谨慎评估并积极早期干预治疗。

Objective: To discuss the long term prognosis of patients with acute coronary syndrome(ACS) complicated with malignant tumor undergoing percutaneous coronary intervention(PCI). Methods: A total of 78 patients with ACS complicated with malignant tumor who underwent PCI in the cardiology department of Linyi People’s Hospital from January 2014 to December 2017 were selected retrospectively(the case group);156 ACS patients without malignant tumor undergoing PCI were selected as the control group with the ratio of 1:2. Demographic information, past history(including malignant tumors), medications, PCI, clinical examination, cardiac ultrasound examination, and cardiovascular related risk factors in two groups were collected. All patients were followed up to June 2020, and treatment results and prognosis were compared between the two groups. Results: The mean age in the case group was significantly higher than that in the control group(P < 0.05). There were no significant differences between the two groups in clinical examination, cardiac ultrasound examination and drug treatment(P > 0.05). The proportion of calcification in the case group was significantly higher than that in the control group, while the proportion of chronic total occlusion in the former was significantly lower than that in the latter(all P < 0.05);however, there were no statistically significant differences between the two groups in the type of ACS, the number of pathological vessels, the number of stents implanted and the proportion of other coronary artery lesions(P > 0.05). The cardiovascular mortality in the case group was significantly higher than that in the control group(P < 0.05);there were no statistically significant difference between the two groups in other secondary endpoints such as all-cause death, cardiogenic shock, cardiovascular readmission, second PCI and second coronary artery bypass grafting other than tumor mortality(all P > 0.05). Conclusion: ACS patients with malignant tumor undergoing PCI report high incidence of long-term adverse cardiovascular outcomes, which suggests that ACS patients with malignant tumor should be closely followed up, carefully evaluated and actively intervened from an early stage.