基于潜在类别分析的不同危险特征冠心病患者经皮冠状动脉介入治疗术后回访结局分析

Analysis of follow-up outcomes of coronary heart disease patients with different risk characteristics after percutaneous coronary intervention based on latent class analysis

目的综合讨论行经皮冠状动脉介入治疗(PCI)手术的冠心病患者的多个影响因素与回访结局的关系,为高危冠心病患者的针对性治疗及预防提出科学线索和依据。方法本研究共纳入2011年8月至2017年9月在天津市2家三级甲等医院接受PCI治疗的510例冠心病患者为研究对象。收集患者的一般资料、手术基本信息;并在PCI术后6个月进行回访,获取主要不良心血管事件(MACE)发生情况。采用潜在类别分析将患者进行合理分类,判断出危险因素组合。采用logistic回归分析不同分类组合与MACE发生情况的关系。数据分析采用SAS 9.4软件。结果根据各种危险因素的组合情况,可以将冠心病患者分为5类:中年急性心肌梗死、老年急性心肌梗死三支病变、中年急性心肌梗死三支病变、中年心绞痛三支病变、老年急性心肌梗死,类别概率分别为17%、11%、19%、30%和23%。研究对象在不同分类人群中的MACE发生率从高到低分别为老年急性心肌梗死三支病变组(14.9%)、中年急性心肌梗死三支病变组(14.1%)、老年急性心肌梗死组(9.6%)、中年心绞痛三支病变组(6.5%)和中年急性心肌梗死组(2.2%),差异有统计学意义(P<0.05)。调整性别、吸烟以及冠心病家族史进行多因素logistic回归分析,结果显示,与中年急性心肌梗死组相比,老年急性心肌梗死三支病变组、中年急性心肌梗死三支病变组和老年急性心肌梗死组的MACE风险较高(OR值分别为8.99、8.26和5.70),均有统计学意义(P<0.05),中年心绞痛三支病变组的风险无统计学意义(P>0.05)。结论冠心病患者可分为中年急性心肌梗死、老年急性心肌梗死三支病变、中年急性心肌梗死三支病变、中年心绞痛三支病变和老年急性心肌梗死组5类,不同模式患者回访的MACE事件发生率不同,可以为冠心病患者PCI术后的精准健康管理提供依据。

Objective To discuss comprehensively the relationship between multiple influencing factors of coronary heart disease patients undergoing percutaneous coronary intervention(PCI) surgery and the follow-up outcome,and to provide the scientific clues and basis for the targeted treatment and prevention of high-risk coronary heart disease patients. Methods A total of 510 patients with coronary heart disease receiving PCI treatment in the 2 grade A hospitals of Tianjin from August 2011 to September 2017 were included in this study. The general information and basic operation information were collected,then the patients after PCI were followed up for 6 months,the occurrence of major adverse cardiovascular events(MACE) was obtained. The latent category analysis was used to reasonably classify patients and determine the combination of risk factors. Logistic regression was used to analyze the relationship between different classification combinations and the occurrence of MACE. SAS 9.4 software was used to analyze the data. Results According to the combination of various risk factors,patients with coronary heart disease could be divided into five categories:middle-aged acute myocardial infarction,elderly acute myocardial infarction with three-vessel disease,middle-aged acute myocardial infarction with three-vessel disease,middle-aged angina pectoris with three-vessel disease and elderly acute myocardial infarction;the category probabilities were 17%,11%,19%,30% and 23%,respectively. The order of MACE incidence in different classified subjects was elderly acute myocardial infarction with three-vessel disease group(14.9%),middle-aged acute myocardial infarction with three-vessel disease group(14.1%),elderly acute myocardial infarction group(9.6%),middle-aged angina with three-vessel disease group(6.5%) and middle-aged acute myocardial infarction group(2.2%),P<0.05. Multivariate logistic regression analysis after adjusting gender,smoking and family history of coronary heart disease showed that as compared with the middle-aged acute myocardial infarction group,the elderly acute myocardial infarction with three-vessel disease group,the middle-aged acute myocardial infarction with three-vessel disease group,and the elderly acute myocardial infarction group had a higher risk of MACE(OR were 8.99,8.26 and 5.70,respectively,P<0.05). The risk of middle-aged angina with three-vessel disease was not statistically significant(P >0.05). Conclusion Patients with coronary heart disease could be divided into middle-aged acute myocardial infarction,elderly acute myocardial infarction with three-vessel disease,middle-aged acute myocardial infarction with three-vessel disease,middle-aged angina pectoris with three-vessel disease,and elderly acute myocardial infarction group. The incidences of MACE followed up in different model patients were different,which could provide the basis for accurate health management of patients with coronary heart disease after PCI.