非罪犯血管临界病变进展并接受支架介入治疗的危险因素预测评分  

Risk Factor Scoring System in Patients of Intermediate Non-Culprit Lesion Progress With Percutaneous Coronary Intervention

作　　者：延荣强[1] 陈纪林[1] 高立建[1] 杨跃进[1] 李建军[1] 乔树宾[1] 徐波[1] 姚民[1] 秦学文[1] 刘海波[1] 吴永健[1] 袁晋青[1] 陈珏[1] 戴军[1] 高润霖[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院冠心病诊治中心,北京市100037

出　　处：《中国循环杂志》2012年第5期330-333,共4页Chinese Circulation Journal

基　　金：首都医学发展科研基金(No.C03030201)

摘　　要：目的:回顾性分析非罪犯血管临界病变进展并接受支架介入治疗的危险因素,建立危险因素预测评分,探讨早期鉴别高危非罪犯血管临界病变的临床意义。方法:选取我院234例患者,在冠状动脉(冠脉)罪犯病变介入治疗时发现有非罪犯血管临界病变并在(10.5±7.9)月后随访造影。根据随访期间非罪犯血管临界病变进展是否接受介入治疗,分为介入治疗组(n=86)和非介入治疗组(n=148)。探讨非罪犯血管临界病变进展并接受支架治疗的危险因素预测评分。结果:介入治疗组比非介入治疗组的2型糖尿病的发生率(43.0%vs 29.7%)及吸烟者所占比例(67.4%vs52.0%)均高,差异有统计学意义(P<0.05)。首次冠脉造影(冠造)的结果介入治疗组比非介入治疗组的血管最小内径小,病变长度长;10个月随访冠造结果介入治疗组比非介入治疗组的血管最小内径小、病变长度长、管腔丢失多、狭窄程度进展快。上述比较差异均有统计学意义(P<0.05)。多因素分析显示复杂病变(B2/C)、钙化病变、分叉病变、吸烟及2型糖尿病等危险因素是非罪犯血管临界病变容易进展并接受介入治疗的独立预测因子。危险因素预测评分为3、4和5的患者非罪犯血管临界病变接受支架治疗的比例分别是58.1%、93.3%和100.0%,其中68.3%危险评分≥3的患者非罪犯血管临界病变接受了支架介入治疗。结论:冠脉介入术中发现的非罪犯血管临界病变,危险因素预测评分≥3的高危患者,应接受积极血运重建的治疗策略。Objective： To study the risk factor scoring system in patients of intermediate non-culprit lesion（NCL） progress with percu- taneous coronary intervention（PCI） and to explore the clinical significance for early identification of high risk coronary intermedi- ate NCL. Methods： We retrospectively studied 234 patients with coronary intermediate NCL, the lesions were found during the initial culprit vessel drug-eluting stent implantation. Those lesions were followed-up by coronary angiography （CAG） at （10. 5 ±7.9 ） months thereafter. The patients were divided into two groups according to PCI conduction during follow-up period as PCI group, n= 86,and Non-PCI group, n = 148. The intermediate NCL progress and the risk factor score for receiving PCI treatment were assessed. Results ：The occurrence of type 2 diabetes and the smokers in PCI group and Non-PCI group were as（43. 0 vs. 29. 7）% and （67.4% vs. 52. 0）% ,P〈0.05 respectively. By initial CAG,eompared with Non-PCI group,PCI group had smaller vessel diame- ter and longer lesion; and by follow-up CAG, PCI group also had smaller vessel diameter,longer lesion, more lumen loss and faster progress for stenosis, all P〈0. 05. Multivariate analysis revealed that complex lesion （B2/C）, calcification, branch point lesion, smoking and type 2 diabetes were the independent risk predictors for receiving PCI in patients with coronary intermediate NCL progress. The patients with risk scores at 3,4 and 5 received PCI rate were at 58.1% ,93. 3% and 100% respectively. There were 68.3% patients with risk score ≥3 received PCI. Conclusion： The patients of coronary intermediate NCL progress with risk score ≥3 would better receive PCI.

关 键 词：冠状动脉临界病变 介入治疗 药物支架 

分 类 号：R541[医药卫生—心血管疾病]