老年冠状动脉临界病变患者功能性缺血的危险因素分析

Analysis of risk factors for functional ischemia in elderly patients with intermediate coronary artery stenosis

目的探讨老年冠状动脉临界病变患者功能性缺血的危险因素,并分析其对于功能性缺血的诊断价值。方法连续回顾性筛选2014年1月至2021年10月于首都医科大学附属北京安贞医院行冠状动脉造影后因临界病变而接受血流储备分数(FFR)检查的672例老年冠心病患者的临床基本资料及手术情况,最终纳入218例单支冠状动脉临界病变患者。根据FFR的结果,分为FFR<0.8组96例,FFR≥0.8组122例,比较2组临床资料并分析与FFR<0.8相关的影响因素。结果FFR<0.8组体质量指数、白细胞计数、尿酸均显著高于FFR≥0.8组,HDL-C水平显著低于FFR≥0.8组(P<0.05,P<0.01)。多因素logistic回归分析显示,尿酸(OR=1.005,95%CI:1.001~1.010,P=0.011)和白细胞计数(OR=1.340,95%CI:1.095~1.641,P=0.005)是影响冠状动脉功能性缺血的独立危险因素。ROC曲线分析显示,回归方程、尿酸和白细胞计数的曲线下面积分别为0.693、0.647和0.623。结论对于老年冠状动脉临界病变患者,尿酸和白细胞计数升高是功能性缺血的独立危险因素。

Objective To investigate the risk factors of functional ischemia in elderly patients with intermediate coronary artery stenosis and to analyze their diagnostic values for functional ischemia.Methods We retrospectively analyzed the basic clinical data and procedures of 672 elderly consecutive patients with coronary artery disease who underwent fraction flow reserve(FFR)examination due to intermediate coronary stenosis after coronary angiography in our hospital from January 2014 to October 2021.Finally,we included 218 patients with single-vessel coronary artery intermediate stenosis.According to the results of FFR,they were divided into two groups,FFR<0.8(n=96)and FFR≥0.8(n=122),and the clinical data were compared between the 2 groups and the influencing factors associated with FFR<0.8 were analyzed.Results The FFR<0.8 group had significantly higher body mass index,white blood cell(WBC)count and uric acid(UA)level,and lower high-density lipoprotein-cholesterol level when compared with the FFR≥0.8 group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that UA level(OR=1.005,95%CI:1.001-1.010)and WBC count(OR=1.340,95%CI:1.095-1.641)were independent risk factors for FFR<0.8.ROC analysis indicated that the area under the curve for logistic regression equation,UA and WBC were 0.693,0.647 and 0.623,respectively.Conclusion In elderly patients with intermediate coronary artery stenosis,elevated UA level and WBC count are independent risk factors for functional ischemia and have certain predictive value.