不同年龄段急性冠状动脉综合征患者经皮冠状动脉介入治疗后体质量与预后关系

Relationship between body mass and prognosis after percutaneous coronary intervention in patients with acute coronary syndrome in different age groups

目的分析不同年龄段急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后体质量与预后的关系。方法选取北部战区总医院自2016年3月至2019年3月收治的接受PCI的5986例ACS患者为研究对象,所有入组患者均在PCI中植入二代药物洗脱支架,且在术后接受至少1年的双联抗血小板药物治疗。根据患者年龄,将其分入年龄<65岁组、年龄65~75岁组及年龄>75岁组,比较各年龄组患者的终点事件发生情况。再根据患者体质量指数(BMI),将患者分入BMI<25 kg/m^(2)组、25 kg/m^(2)≤BMI<30 kg/m^(2)组及BMI≥30 kg/m^(2)组,比较各年龄组及BMI亚组患者的终点事件发生情况、主要终点事件生存曲线。结果年龄<65岁组、年龄65~75岁组的主要终点事件和全因死亡发生率与BMI无关(P>0.05);在年龄>75岁组中,随着BMI增大,主要终点事件和全因死亡发生率呈降低趋势,但也与BMI无关(P>0.05)。在年龄<65岁组、年龄65~75岁组、年龄>75岁组中,出血学术研究联合会(BARC)3~5型出血发生率均与BMI无关(P>0.05)。在主要终点事件、全因死亡、BARC 3~5型出血中,年龄与BMI交互作用均无显著性(交互P值分别为0.1283、0.4368、0.4793,P值均>0.05)。在年龄<65岁组、年龄65~75岁组、年龄>75岁组中,不同BMI分组的主要终点事件生存曲线比较,差异无统计学意义(P>0.05)。结论ACS患者PCI后“肥胖悖论”现象可能主要存在于高龄群体。

Objective To analyze the relationship between body mass and prognosis in patients with acute coronary syndrome(ACS)in different age groups after percutaneous coronary intervention(PCI).Methods A total of 5986 patients with ACS who underwent PCI in General Hospital of Northern Theater Command from March 2016 to March 2019 were selected as the study subjects.All patients were implanted with second-generation drug-eluting stents during PCI and received dual antiplatelet therapy for at least 1 year after surgery.According to the age of the patients,the patients were divided into the age<65 years old group,age 65-75 years old group and age>75 years old group,and the occurrence of endpoint events of the patients in each age group was compared.According to the body mass index(BMI)of the patients,the patients were divided into BMI<25 kg/m^(2)group,25 kg/m^(2)≤BMI<30 kg/m^(2)group and BMI≥30 kg/m^(2)group,and the occurrence of end-point events and survival curves of primary end-point events were compared among all age groups and BMI subgroups.Results The incidence of all-cause death and primary endpoint events in age<65 years old group and age 65-75 years old group were not correlated with BMI(P>0.05).In the age>75 years old group,the incidence of primary endpoint events and all-cause death decreased with increasing BMI,but was not associated with BMI(P>0.05).The incidence of Bleeding Academic Research Consortium(BARC)3-5 hemorrhage was not associated with BMI in the age<65 years old group,age 65-75 years old group and age>75 years old group(P>0.05).There was no significant interaction between age and BMI in primary endpoint events,all-cause death,and BARC 3-5 hemorrhage(P=0.1283,0.4368,0.4793,respectively,all P>0.05).In the age<65 years old group,age 65-75 years old group and age>75 years old group,there was no statistically significant difference in the survival curve of the main endpoint event among different BMI groups(P>0.05).Conclusion The phenomenon of“obesity paradox”in ACS patients after PCI may mainly exist in the elderly group.