真实世界急性冠脉综合征多支血管病变的预后分析  

Prognosis analysis of patients with acute coronary syndrome and multi-vessel disease in the ＂real world＂

作　　者：余言午 高彦娜 张瑞芳[2] 张晓娟[1] 宋盈盈[1] 孙清雅 张艳艳[1] 万有栋[1] 孙同文[1] 阚全程[3] 

机构地区：[1]郑州大学第一附属医院综合ICU,河南省重症医学重点实验室,郑州450052 [2]郑州大学第一附属医院超声科,郑州450052 [3]郑州大学第一附属医院药剂科,郑州450052 [4]平顶山第一人民医院ICU

出　　处：《中华急诊医学杂志》2017年第1期90-95,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（81370364）;河南省高校科技创新团队,河南省教育厅（16IRTSTHN021）;河南省医学科技攻关计划省部共建项目（201301005）;十二五国家科技支撑项目子课题（2014BA108801）;河南省科技成果转化项目（122102310584）

摘　　要：目的比较真实世界中急性冠脉综合征（ACS）多支血管病变（multivessel disease）患者药物治疗、经皮冠状动脉介入治疗（PCI）和冠脉搭桥术（coronary artery bypass graft，CABG）的长期疗效差异。方法选取自2012年8月至2013年6月在郑州大学第一附属医院住院，冠状动脉造影显示多支血管病变的ACS患者。记录患者临床资料，按治疗策略不同分为药物治疗组、PCI组和CABG组。采用门诊、电话和查阅再次住院病历的策略进行随访，记录终点事件的发生情况。主要终点事件为全因死亡，次要终点事件包括心肌梗死，再次血运重建，因心绞痛、心衰、脑卒中再入院。应用SPSS17．0对数据进行统计分析。结果（1）共入选患者725例，成功随访655例（90．3％），随访时间（30．6±5．5）个月。177例发生终点事件（27．0％），其中死亡33例（5．0％）。（2）3组患者全因死亡、再发心肌梗死、因脑卒中和心衰再入院的发生率差异均无统计学意义（P〉0．05）；与药物治疗组比较，PCI组再次血运重建（2．3％vs．12．0％，P〈0．01）、心绞痛（8．8％vs．17．6％，P=0．005）、总终点事件（20．7％vs.47．9％，P〈0．01）的发生率较低；与药物治疗组比较，CABG组再次血运重建（1．9％vs．12％，P〈0．01）、总终点事件（22．4％vs．47．9％，P〈0．01）的发生率较低；PCI组与CABG组比较，单个终点事件及总终点事件的发生率均差异无统计学意义（P〉0．05）。（3）多因素Cox比例风险回归分析显示：年龄（RR=1．062，95％CI：1．044-1．080，P〈0．0t），高血压（RR=1．385，95％CI：1．007-1．905，P=0．045），未服他汀类药物（RR=1．452，95％CI：1．008-2．093，P=0．045）是终点事件发生的独立危险因素（P〈0．05）。（4）Kalan-Meier生存曲线分析显示，3组无终点事件的累积生存率差异有统计学意义（P=0�Objective To compare the long term efficacy among medicine intervention, percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） in patients with acute coronary syndrome （ACS） and multi-vessel disease in the ＂real world＂. Methods Patients with ACS and multi- vessel disease in the First Affiliated Hospital of Zhengzhou University admitted from August 2012 to June 2013 were enrolled in this study. These patients were divided into three groups according to different modalities of treatment： namely medicine intervention group, PCI group and CABG group. Clinical follow- up was done through patients＇ visit, telephone interview and medical record review and end events were recorded. The primary end point was death owing to all causes, and the secondary end points included recuurence of myocardial infarction, revascularization, re-admission due to angina pectoris, heart failure and stroke. The data was analyzed by SPSS 17. 0. Results （ 1 ） There were 725 patients enrolled in the analysis and 655 （90. 3% ） of them were successfully followed up. Mean follow-up time was （30. 6±5.5） months. There were 177 （27. 0% ） cases subjected to end points, including 33 （5.0%） death. （2） There were no significant differences found in rate of death from all causees, recurrence of myocardial infarction or re-admission because of heart failure and stroke among these three groups. Compared with medicine intervention group, PCI group was associated with reductions in the rates of revascularization （2. 3% vs. 12. 0%, P 〈0. 01 ）, angina pectoris （8. 8% vs. 17. 6%, P =0. 005） and the total end events （22.4% vs. 47.9%, P 〈 0.01 ）. Compared with medicine intervention group, CABG group showed lower rates of revascularization （ 1.9% vs. 12% , P 〈0.01 ） and total end events （ 22.4% vs. 47.9% , P 〈0. 01 ）. There were not significant difference in rates of single end event and total end events between PCI group and CABG group. （3） Multivariate Cox

关 键 词：急性冠脉综合征 多支血管病变 药物治疗 介入治疗 冠脉搭桥术 终点事件 

分 类 号：R541.4[医药卫生—心血管疾病]