老年冠状动脉钙化患者冠状动脉旋磨术中并发症及术后短期主要不良心血管事件的影响因素

Influencing factors of intraoperative complications and short-term postoperative major adverse cardiovascular events in rotational atherectomy among elderly patients with coronary artery calcification

目的 探讨老年冠状动脉钙化(CAC)患者冠状动脉旋磨(RA)术中并发症及术后短期(12个月内)主要不良心血管事件(MACE)的影响因素。方法 收集2017年1月至2020年12月于宜宾市第三人民医院行RA的老年CAC患者188例,参照《冠状动脉内旋磨术中国专家共识》进行手术,随访术后12个月内MACE发生情况,按照12个月内是否发生MACE分为试验组和对照组。采用SPSS 25.0软件进行统计分析。根据数据类型组间比较采用t检验或χ2检验。采用多因素logistic回归分析术中并发症和术后12个月内MACE的影响因素。结果 术中并发症和术后12个月内MACE的发生率分别为17.02%(32/188)和18.62%(35/188),发生术中并发症组和未发生术中并发症组患者体质量指数、吸烟史、心力衰竭史、高血压史、既往心肌梗死史、病变血管、SYNTAX评分、凝血酶原时间、糖化血红蛋白(HbA1c)、最小管腔直径(MLD)、管腔横切面积和旋磨头血管内径比比较,差异均有统计学意义(P<0.05)。多因素分析显示:心力衰竭史、病变血管(双支、三支、左主干支相对于单支)、SYNTAX评分、MLD及旋磨头血管内径比是术中并发症的影响因素[OR=0.518,(1.660、2.311和3.089),3.893,0.794,0.641;均P<0.05];术后12个月MACE的影响因素有心力衰竭史、高血压史、SYNTAX评分、HbA1c和MLD(OR=0.481,0.812,2.777,0.762,0.721;均P<0.05)。结论 旋磨术中并发症可能与患者心力衰竭史、病变血管、SYNTAX评分、MLD及旋磨头血管内径比有关,而心力衰竭史、高血压史、SYNTAX评分、HbA1c和MLD则可能是术后短期发生MACE的独立预测因素。

Objective To explore the influencing factors of intraoperative complications and short-term postoperative major adverse cardiovascular events(MACE)in rotational atherectomy(RA)among the elderly patients with coronary artery calcification(CAC).Methods From January 2017 to December 2020,188 elderly CAC patients who underwent RA in the Third People′s Hospital of Yibin were collected.The operation was performed according to the Chinese Expert Consensus on Rotational Atherectomy.The patients were followed up for MACEs for 12 months after operation and were divided into study group and control group based on the occurrence of MACEs within 12 months.SPSS 25.0 was used for statistical analysis.Comparison between groups was made using t-test or chi-square test according to the data type.Multivariate logistic regression was used to analyze the influencing factors of the intraoperative complications and postoperative MACE within 12 months.Results The incidence was 17.02%(32/188)for the intraoperative complications and 18.62%(35/188)for MACE within 12 months after the operation.There were statistically significant differences between MACE and non-MACE patients in body mass index,history of smoking,history of heart failure,history of hypertension,history of previous myocardial infarction,diseased vessels,SYNTAX score,prothrombin time,glycosylated hemoglobin A1c(HbA1c),minimum lumen diameter(MLD),cross section area(CSA),and ratio of rotary burr to vessel diameter(P<0.05 for all).Multivariate analysis showed that the history of heart failure,angiopathic vessels(double,triple vessels and left main branch compared with single vessel),SYNTAX score,MLD,and ratio of rotary burr to vessel diameter were the influencing factors of intraoperative complications[OR=0.518,(1.660,2.311 and 3.089),3.893,0.794,0.641;all P<0.05].The influencing factors of MACE within 12 months after operation were the history of heart failure,history of hypertension,SYNTAX score,HbA1c and MLD(OR=0.481,0.812,2.777,0.762,0.721;all P<0.05).Conclusion Complications of RA may be related to the history of heart failure,angiopathic vessel,SYNTAX score,MLD,and ratio of rotary burr to vessel diameter;the history of heart failure,history of hypertension,SYNTAX score,HbA1c and MLD may be independent predictors of short-term postoperative MACE.