影响老年冠心病患者血运重建术后死亡的危险因素  

Risk factors related to mortality in old patients with coronary heart disease after revascularization

作　　者：刘小慧[1] 康俊萍[1] 杜昕[1] 聂绍平[1] 吕强[1] 董建增[1] 刘新民[1] 赵希哲[1] 顾承雄[1] 黄方炯[1] 吕树铮[1] 陈方[1] 周玉杰[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2007年第8期701-705,共5页Chinese Journal of Cardiology

基　　金：国家重点基础研究发展规划资金(2003CB517103)

摘　　要：目的了解影响老年冠心病患者血运重建术后死亡的危险因素。方法在药物洗脱支架对血运重建影响研究(DESIRE)数据库中,入选2003年7月1日至2004年6月30日在我院接受冠状动脉血运重建术,年龄70岁以上,出院后随访>30天的冠心病患者675例,男性498例,女性177例。记录患者的临床特点、随访期间死亡和主要不良心脑血管事件(MACCE)发生情况。结果平均随访(754±355)天。随访中死亡27例(4.0%),发生 MACCE 50例(7.4%),多因素 Cox 回归分析,校正其他因素后,与男性患者相比,女性患者死亡的危险为2.750(95% CI 1.116～6.779,P=0.028);合并贫血患者死亡危险为0.385(95% CI 0.164～0.904,P=0.028);血肌酐(Cr)水平越高,死亡危险越大,肾功能减低者(Cr≥115μmol/L)死亡危险为2.963(95% CI 1.114～9.952,P=0.035),肾功能不全者(Cr≥177μmol/L)死亡危险为10.785(95% CI 2.659～78.097,P=0.000)。结论影响血运重建后老年冠心病患者死亡的危险因素是性别、血运重建前血红蛋白和 Cr 水平。女性、贫血和肾功能减低的冠心病患者血运重建后远期预后不良,死亡率高。术前应认识这些危险因素并加以纠正,将有利于改善血运重建后老年冠心病患者的远期预后。Objective To evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization. Methods A total of 675 patients （49B males） with age≥70 years old who received revascularization during July 2003 to June 2004 and followed up 〉 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events （MACCE） during follow up were recorded. Results The patients were followed up for a mean period of （754 ±355） days. 27 patients （4. 0% ） died and MACCE developed in 50 patients （7.4%） during follow up. Female and patients with anemia took a significantly higher risk of mortality （RR = 2. 750, 95% CI 1.116-6. 779, P = 0. 028, RR = 0. 385 95% CI 0. 164-0. 904, P = 0. 028, respectively） ; Creatinine level is positively related to mortality rate. When comparing patients with Cr 〉 115 μmol/L and Cr 〉 177μmol/L with patients with Cr 〈 115 μmol/L, the hazard rate was 2. 963 and 10. 785, respectively （95% CI 1. 114- 9. 952, P = 0.035 and 95% CI 2. 659-78.097, P = 0.000） after adjustment for other risk factors. Conclusion Preexisting anaemia（ male Hb 〈 120 g/L,female Hb 〈 110 g/L）, renal insufficiency （Cr 〉 115 μmol/L） and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease pest revascularization.

关 键 词：冠状动脉疾病 心肌血管重建术 老年人 危险因素 预后 

分 类 号：R541.4[医药卫生—心血管疾病]