冠状动脉造影中重度钙化病变患者介入治疗后的长期预后及不良心血管事件独立危险因素研究

Long-term Clinical Outcomes and Risk Factors of Cardiovascular Events Post Percutaneous Coronary Intervention in Patients With Moderate to Severe Calcified Coronary Lesions

目的:分析冠状动脉造影提示具有中重度钙化病变患者接受经皮冠状动脉介入治疗(PCI)后的长期预后特征及发生不良心血管事件的独立危险因素。方法:前瞻性连续纳入2017年1月至2018年12月在我院行PCI的患者26771例。依据冠状动脉造影提示的钙化病变程度,将患者分为无或轻度钙化组和中重度钙化组,比较两组PCI后的长期预后特征及发生不良心血管事件的危险因素。主要终点事件为3年靶血管失败(TVF),包括心原性死亡、靶血管相关心肌梗死(TV-MI)及靶血管相关血运重建(TVR)在内的复合终点事件。结果:中重度钙化病变患者4105例(15.33%),无或轻度钙化患者22666例(84.67%)。与无或轻度钙化组比,中重度钙化病变组患者年龄较大,男性比例较高,病变较为复杂(包括累及三支病变或左主干病变、开口处病变和慢性完全闭塞病变),P均<0.05。中位随访时间3年,中重度钙化患者具有更高的TVF率(5.31%vs.4.65%;HR=1.162,95%CI:1.004~1.344,P=0.044)、心原性死亡率(1.24%vs.0.64%;HR=1.996,95%CI:1.451~2.747,P<0.001)以及TV-MI发生率(0.85%vs.0.61%;HR=1.449,95%CI:1.000~2.101,P=0.049)。Cox多元回归分析显示,高龄、术前SYNTAX评分高、合并三支或左主干病变、支架内再狭窄病变以及未使用血管内超声是中重度钙化患者发生不良心血管事件独立危险因素(P均<0.05)。结论:冠状动脉造影提示具有中重度钙化病变患者在接受PCI后,其TVF、心原性死亡、TV-MI发生风险均高于无或轻度钙化患者。高龄、合并复杂冠状动脉病变以及未使用血管内超声是中重度钙化患者不良预后的独立危险因素。

Objectives:To analyze the long-term clinical outcome and risk factors for adverse cardiovascular events in patients with moderate to severe calcified coronary lesions detected by coronary angiography(CAG),who received percutaneous coronary intervention(PCI).Methods:We prospective collected 26771 patients who underwent PCI at Fuwai Hospital,Chinese Academy of Medical Sciences from 2017 to 2018.According to the degree of coronary calcification indicated by CAG,patients were divided into no or mild coronary calcification group and moderate to severe coronary calcification group.The long-term clinical outcome and risk factors for adverse cardiovascular events were compared between the two groups.The primary endpoint was 3-year target vessel failure(TVF),a composite endpoint including cardiovascular death,target vessel related myocardial infarction(TV-MI),and target vessel related revascularization(TVR).Results:There were 4105 patients(15.33%)with moderate to severe coronary calcification lesions,and 22666 patients(84.67%)with no or mild coronary calcification.Patients with moderate to severe calcified lesions had a higher risk of TVF(5.31%vs.4.65%;HR=1.162,95%CI:1.004-1.344,P=0.044),cardiovascular mortality(1.24%vs.0.64%;HR=1.996,95%CI:1.451-2.747,P<0.001),and TV-MI(0.85%vs.0.61%;HR=1.449,95%CI:1.000-2.101,P=0.049).Multivariable Cox regression analysis showed that elderly age,complex lesions,and the non-intravascular ultrasound(IVUS)-guide PCI were independent risk factors for worse outcome in patients with moderate to severe calcified coronary lesions(all P<0.05).Conclusions:Patients with moderate to severe coronary calcification indicated by CAG and underwent PCI are associated with a higher risk of TVF,cardiovascular mortality,and TV-MI compared to those without calcification or with mild coronary calcification.Elderly age,complex lesions,and the non-intravascular ultrasound(IVUS)-guide PCI are independent risk factors of worse clinical outcome in patients with moderate to severe calcified coronary lesions.