冠心病患者植入国产药物洗脱支架的长期预后分析  

Long-term prognosis of patients with coronary artery disease treated with domestic drug-eluting stent

作　　者：姚海木[1] 付新[1] 孙同文[2] 张晓娟[2] 沈德良[1] 张金盈[1] 李凌[1] 

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052 [2]郑州大学第一附属医院综合ICU,河南郑州450052

出　　处：《中国医药科学》2015年第19期9-14,共6页China Medicine And Pharmacy

摘　　要：目的探讨冠心病患者植入国产药物洗脱支架的长期预后及临床事件的相关危险因素。方法选取2009年7月~2010年12月所有在郑州大学第一附属医院心内科成功行经皮冠状动脉介入治疗（PCI）并至少植入一个国产DES冠心病患者。排除标准：植入金属裸支架或混合植入支架（同时植入国产和进口DES）。收集患者临床及介入相关资料,采用门诊、电话和查阅再次住院病历的方法进行随访,记录临床不良事件的发生情况。数据变量应用单因素方差分析,分类数据的比较用x2检验或精确概率计算。采用多因素Logistic逐步回归判断PCI后预后危险因素。结果共入选患者1228例,成功随访1136例（92.5%）,随访时间（29.1±5.9）个月。急诊PCI占2.5%,择期PCI占18.4%,NSTE-ACS占66%,稳定型心绞痛占13%。急诊PCI组院内死亡率最高（3.4%）,随访期间死亡率5.7%,再发心肌梗死率2.6%,血运重建率6.6%,MACCE（死亡、心肌梗死和脑血管病）发生率9.94%,支架内再狭窄发生率3.7%。多因素回归分析显示：高龄、心率快、低LVEF、多支病变和再狭窄病变是长期MACCE发生的独立预测因素。结论急诊PCI患者院内和长期预后最差,已知的冠心病死亡危险因素对PCI预后有着重要的负面影响。Objective To investigate the long-term prognosis and factors associated with clinical events of patients with coronary artery disease（CAD）treated with domestic drug-eluting stent. Methods All patients with CAD undergone percutaneous coronary intervention（PCI）successfully and,at least,implanted one domestic drug-eluting stent in the first affiliated hospital of Zhengzhou university from July 2009 to December 2010 were included in the analysis.Exclusion criteria were patients implanted with bare metal stent or different stents（domestic and imported DES）simultaneously.Clinical,laboratory,angiographic and procedural data were collected.The follow-up was conducted by outpatient interviews,reviewing hospital records and via telephone interviews and adverse cardiac events were recorded.Comparisons among continuous variables were made by using one-way ANOVA.Categorical data were tested using x2 test or the Fisher exact test.Multivariate Logistic regression analysis was performed to identify independent predictors of prognosis.All statistical analyses. Results There were a total of 1228 patients enrolled in the analysis and a follow up after 29 months was obtained in 1136 patients（92.5%）,Follow-up time was（29.1±5.9） months.Patients with urgent PCI accounted for 2.5% of cases,patients with non-urgent PCI amounted to 18.4%,patients with NSTE-ACS consisted of 66% and patients with stable angina constituted 13%.The highest mortality during the hospitalization was noted within the urgent PCI group（3.4%）.During follow up, death occurred in 5.7%,re-myocardial infarction in 2.6%,revascularization in 6.6%,in-stent restenosis in 3.7% and MACCE（death/myocardial infarction/stroke）in 9.94%.Multiple regression model showed that independent risk factors for MACCE during the follow up were：older age,heart rate,decreased left ventricular ejection fraction,multivessel disease,and restenostic lesions. Conclusion In the real life PCI practice STEMI patients undergone urgent PCI have the worst hospital and longt

关 键 词：长期预后 冠心病 经皮冠状动脉介入术 药物洗脱支架 

分 类 号：R541.4[医药卫生—心血管疾病]