冠心病三支病变不良预后患者临床特点与治疗策略分析  

Clinical Characteristics and Treatment Strategy Situation Analysis for Adverse-outcome Patients with Three-vessel Coronary Artery Disease

作　　者：刘如[1] 许晶晶[1] 姜琳[1] 许连军[1] 宋莹[1] 王欢欢[1] 唐晓芳[1] 蒋萍[1] 宋雷[1] 袁晋青[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外医院国家心脏病中心,北京100037

出　　处：《华中科技大学学报（医学版）》2017年第6期673-679,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家重点基础研究发展计划资助项目(No.2010CB732601);国家高技术研究发展计划资助项目(No.2015AA020407);国家自然科学基金资助项目(No.81470380);国家科技支撑计划资助项目(No.2016YFC1301301);中国医学科学院医学与健康科技创新工程资助项目(No.2016-I2M-1-002)

摘　　要：目的探讨冠心病三支病变(three-vessel disease,TVD)预后不良患者的临床特点,以及经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)和单纯药物治疗等3种治疗方式对远期预后的影响,以期为临床治疗策略提供参考。方法连续入组2004年4月至2011年2月在阜外医院入院的TVD患者8 943例。对所收集的TVD患者大样本随访得到的1年主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular events,MACCE)组和非MACCE组进行临床因素和治疗策略对比分析。结果与非MACCE组相比,MACCE组年龄更大、心肾功能更差、合并症包括糖尿病、卒中等更多,冠脉病变更复杂。校正多因素后,血肌酐水平、出院带药阿司匹林独立影响MACCE。MACCE组和非MACCE组患者治疗策略存在明显差异(P<0.01)。MACCE组血运重建显著少于非MACCE组(64.9%vs.76.2%,P<0.01),其中PCI组间无差异(46.1%vs.46.2%,P=0.533);差异来自MACCE组CABG显著少于非MACCE组(18.8%vs.30.0%,P<0.01),而单纯药物治疗显著多于非MACCE组(35.1%vs.23.8%,P<0.01)。结论肾功能和服用阿司匹林是TVD患者心脑血管不良事件的独立影响因素。非MACCE组患者血运重建要显著多于MACCE组患者。血运重建可能是改善TVD患者预后的重要因素。Objective To discuss the clinical characteristics of three-vessel coronary artery disease and how treatment strategy influences long-term outcome.Methods A total of 8 943 consecutive cases with three-vessel disease in a single center from April 2004 to February 2011 were prospectively collected.Major adverse cardiovascular and cerebrovascular events(MACCE)included all-cause death,acute myocardial infarction,revascularization,readmission and stroke.Clinical characteristics and treatment strategies were compared between MACCE group and non-MACCE group.Results As compared with non-MACCE group,patients in the MACCE group were associated with older age,worse cardiac and renal function,more comorbidities including diabetes mellitus and stroke,more complicated coronary lesions.After multivariate adjustment,serum creatine level and discharge medication of aspirin were independent predictors for MACCE.Treatment strategy was significantly different between MACCE group and non-MACCE group(P<0.01).Revascularization rate was significantly lower in the MACCE group than in the non-MACCE group(64.9%vs.76.2%,P<0.01).While PCI rate showed no difference between the two groups(46.1%vs.46.2%,P=0.533).CABG rate was significantly lower in the MACCE group than in the non-MACCE group(18.8%vs.30.0%,P<0.01).Pure medication therapy rate was significantly higher in the MACCE group than in the non-MACCE group(35.1%vs.23.8%,P<0.01).Conclusion Renal function and discharge medication of aspirin are independent predictors for MACCE in TVD patients.Revascularization is performed more frequently in MACCE group than in non-MACCE group significantly.Revascularization may be an important factor to improve outcome of TVD patients.

关 键 词：冠心病 三支病变 主要心脑血管不良事件 治疗策略 

分 类 号：R541.4[医药卫生—心血管疾病]