冠心病患者426例远期随访研究及影响因素分析  

Long-term follow-up study of prognosis and analysis of influencing factors in 426 coronary heart disease patients

作　　者：王国位[1] 刘宏斌[2] 

机构地区：[1]兰州军区乌鲁木齐总医院心内科,830000 [2]中国人民解放军总医院心内科

出　　处：《中国介入心脏病学杂志》2013年第4期230-234,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的研究冠心病患者远期主要心脑血管事件(MACCE)的发生率及危险因素。方法对2004年1月至2006年3月连续就诊于解放军总医院心内科,经冠状动脉血运重建治疗(冠动状脉介入治疗或冠状动脉旁路移植术)的冠心病患者426例进行电话、再住院及信访调查,为单中心非对照登记研究;观察患者的临床特点、检查指标、手术资料对主要心脑血管事件发生的影响。主要终点:MACCE[包括全因死亡、再次心肌梗死(Re-MI)、靶病变/靶血管再次血运重建(TVR/TLR)、脑血管意外]发生情况;次要终点:心绞痛复发和非靶病变/靶血管再次血运重建(非TVR/TLR)。结果 426例冠心病患者成功完成6年的临床随访,平均随访时间(60.59±6.15)个月,中位随访时间60个月。6年MACCE累计发生84例(19.7%),其中Re-MI33例(7.7%)、TVR/TLR48例(11.3%)、全因死亡20例(4.7%)、心性死亡15例(3.5%),次要终点心绞痛复发139例(32.6%),非TVR/TLR23例(5.4%)。Cox回归模型分析显示陈旧性心肌梗死(OMI)(β=3.98,OR=53.47,95%CI3.59～795.74,P=0.004,)、卒中史(β=5.43,OR=228.31,95%CI8.21～635.36,P=0.001)、心律失常史(β=6.37,OR=586.44,95%CI5.44～6319.54,P=0.008)、吸烟史(β=1.6,OR=4.95,95%CI1.34～18.31,P=0.016)、高血压病史(β=2.78,OR=16.18,95%CI2.75～95.04,P=0.002)、病变血管数(β=3.029,OR=20.67,95%CI3.056～139.829,P=0.002)为MACCE发生的主要影响因素。生存曲线在术后第1年和第4～5年下降较为明显。结论 OMI、心律失常史、卒中史、高血压病史及病变血管数协同影响着本人群的远期预后。术后第1年和第4～5年间可能是MACCE高发的两个"时间窗"。Objective To follow up and study the long-term incidence of the major adverse cardiac and eerebrovascular events （ MACCE ） and the influencing factors of coronary heart disease patients in our centre. Methods Four hundred and twenty six patients who underwent revascularizatiou （percutaneous coronary intervention or coronary artery bypass graft） from January 2004 to March 2006 were selected in the study. All patients were followed-up by telephone, rehospitalization and mail. This is a single-centre and non-control study. Analysis was done in patients＇ clinical characteristics, examination results, operation information and their influence on incidence of MACCE. The major end point was MACCE （including all- caused death re-myocardial infarction, target vessel revascularization/target lesion revascularization） and the secondary end point were angina pectoris and non-target vessel revascularization. Results All patients finished 6 years follow-up. The mean time of follow-up was 60. 59±6. 15 months and the median time was of 60 months. Incidence of MACCE was 84 patients （ 19.7% ）, including re-MI 33 patients （ 7.7% ）, TVR/ TLR48 patients （11.3%）, all-caused death in 20 patients （4.7%）; angina pectoris in 139 patients （32. 6% ） and not-TVR/TLR in 23 patients（5.4% ）. Cox regression model analysis showed： OMI（~ = 3.98, P = O. 004, OR = 53.47,95 % CI 3.59 - 795.74 ）, srtoke （ β = 5.43, P = 0. 001, OR = 228.31,95 % CI 8. 21 - 635.36）, arhythmia（]3 = 6. 37, P = 0. 008, OR = 586.44,95% C1 5.44 -6319. 54）, smoking （]3 = 1.6, P =0. 016, OR = 4. 95,95 % CI 1.34 - 18.31 ）, hypertension （β = 2. 78, P = 0. 002, OR = 16. 18,95 % CI 2. 75 - 95.04） and the number of lesion vessel（β= 3. 029,P = 0. 002, OR = 20. 67,95 % CI 3. 056 - 139. 829） were main risk factors of MACCE. Survival curve decreased more sharply in 1 year and 4 - 5 years than other time during following-up. Conclusions OMI, srtoke, arhythmia, smoking, hypertension and the number of lesion vessel were in

关 键 词：冠心病 预后 随访研究 COX回归模型 

分 类 号：R543.31[医药卫生—心血管疾病]