老年冠状动脉慢性闭塞性病变患者PCI术后发生主要心血管不良事件的危险因素分析  

Analysis on Related Factors of Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in Elderly Chronic Total Occlusion Patients

作　　者：曹勤 徐宏伟 沙本炎 曾彬[2] 

机构地区：[1]洪湖市中医医院心血管内科,湖北武汉433200 [2]武汉大学人民医院心血管内科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2017年第4期610-613,共4页Medical Journal of Wuhan University

基　　金：国家自然科学基金青年项目(编号:30900609);国家自然科学基金面上项目(编号:81270271;81570333)

摘　　要：目的:探讨老年冠状动脉慢性闭塞性病变(CTO)患者经皮冠状动脉介入治疗(PCI)术后发生主要心血管不良事件(MACE)的可能影响因素。方法:选取2010年1月至2015年11月于我院诊断为CTO并成功行PCI且年龄≥60岁的患者118例为研究对象,术后均对患者随访12个月,并根据是否发生MACE分为MACE组(n=38)和对照组(n=80),比较两组患者基本临床资料、生化资料、介入影像学资料及药物使用差异。结果:两组患者年龄、性别、高血压病史、吸烟饮酒史、支架直径、支架长度等资料差异无统计学意义(P>0.05),但在糖尿病史、超敏C反应蛋白(hs-CRP)、术后慢血流、药物使用(替格瑞洛、β受体阻滞剂)方面差异有统计学意义(P<0.05)。Logistic回归分析表明,可能影响老年冠状动脉慢性闭塞性病变患者PCI术后预后的危险因素中,总胆固醇(OR=1.672,β<0.521,95%CI:1.042-2.247,P<0.05)、hs-CRP(OR=1.348,β<0.264,95%CI:1.032-1.968,P<0.05)、术后慢血流(OR=4.645,β<1.512,95%CI:1.398-10.320,P<0.01)是危险因素,使用替格瑞洛(OR=0.462,β<-0.612,95%CI:0.135-0.912,P<0.05)及β受体阻滞剂(OR=0.398,β<-0.753,95%CI:0.198-0.875,P<0.05)是保护因素。结论:临床对老年CTO患者强化血脂、hs-CRP等指标的监测及管理,合理进行PCI术操作,对高危患者辅以个体化抗血小板治疗将有望减少术后MACE发生并改善预后。Objective： To explore the related etiology factors of major adverse cardiovascular event （MACE） in coronery artery disease （CAD） patients with chronic total ocdusion （CTO）. Methods： 118 CAD patients with CTO who received successful percutaneous coronary intervention （PCI） were enrolled in this study,all subjects had been followed up 12 months after PCI procedure and were divided into MACE group（n=38） and control group（n=80） according to whether combined with MACE（namely myocardio reinfarction, in-stent restenosis, recurrent heart fail-ure and death）. The basic clinical data,laboratory results, PCI procedure and therapeutic of drugs were retrospectively analyzed to figure out the related factors of MACE in CTO patients. Results. Based on bivariate analysis, we found several independent variables with P〈0.05 including diabetes, hs-CRP,TIMI≤2 and the use of ticagrelor or beta blocks, the residual data including laboratory results,PCI procedure, etc. , had no significant statistical significance between the groups. A multivariate logistic regression analysis showed that total cholesterol （OR= 1. 672, β〈0. 521, 95%CI：1. 042-2. 247, P〈0.05）, hsCRP（OR=1. 348, β〈0. 264,95%CI：1. 032-1. 968,P〈0.05 and TIMI≤2（OR=4. 645, β〈1. 512, 95%CI： 1. 398-10. 320, P〈0.01） were independent predictor factors of MACE in CTO patients, on the contrary, the use of ticagrelor （OR= 0.462,β〈- 0.612,95 % CI：0. 135-0.912, P〈0.05）or 13 blocks（OR=0. 398,β〈-0. 753,95%CI：0. 198-0. 875,P〈0.05） might be the protective factors. Conclusion： Clinical treatments for patients with CTO including strengthened monitoring and management of hs-CRP and eholesterd levels. Reasonable PCI procedure and individualized antiplatelet therapy is expected to reduce the incidence of MACE.

关 键 词：慢性闭塞性病变 PCI术 主要心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]