老年左主干病变患者介入治疗预后及影响因素  

Prognosis and Risk Factors of PCI-treated Senile Patients with Unprotected Left Main Coronary Artery Disease: A Follow-up Study

作　　者：高野 邹宜覃 王倩[2] Gao Ye;Zou Yitan;Wang Qian(Cadet Brigade,Second Military Medical University,Shanghai 200433 , Chin)

机构地区：[1]第二军医大学学员旅学员十一队,上海200433 [2]第二军医大学附属长海医院心血管内科

出　　处：《医学研究杂志》2018年第4期94-99,共6页Journal of Medical Research

基　　金：第二军医大学本科学员创新能力孵化基地基金资助项目(FH2016128)

摘　　要：目的 探讨老年无保护左主干(ULMCA)病变患者介入治疗预后及不良事件危险因素。方法 入选单中心年龄≥60岁行PCI治疗的ULMCA病变患者,收集基线资料并随访。记录随访中发生的主要不良心脑血管事件(MACCE),绘制Kapaln-Meier曲线,并采用Cox回归法分析不良预后的影响因素。结果 共182例完成随访,中位随访时间21.5(13,36.5)个月,无MACCE中位生存时间为66个月。共发生MACCE43例(23.63%),其中死亡12例(6.59%)、非致死性心肌梗死1例(0.55%)、非致死性脑血管意外1例(0.55%)、靶血管血运重建29例(15.93%),72.09%的MACCE发生在术后2年内。多因素校正的Cox回归分析显示:左主干支架直径(HR=0.37,95%CI:0.17~0.82,P=0.014)、分叉部病变(HR=1.92,95%CI:1.01~3.62,P=0.045)、吸烟指数>1000年支(HR=3.78,95%CI:1.29~11.05,P=0.015)是MACCE的独立危险因素;Euro SCOREⅡ≥2%(HR=3.96,95%CI:1.15~13.61,P=0.029)是全因死亡的独立危险因素。结论 老年ULMCA病变患者PCI术后总体预后良好,但术后2年内需特别警惕MACCE发生。左主干支架直径较小、左主干分叉部受累、吸烟指数>1000年支、Euro SCOREⅡ≥2%者预后较差。Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery（ULMCA） disease treated with PCI. Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study. All patients were older than 60. The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up.All the major adverse cardiovascular and cerebrovascular events（MACCE） were evaluated throughout the follow-up period. Based on those data,Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors. Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5（13,36.5） months and an estimated median MACCE-free survival time of 66 months by K-M method. During the follow up,all-cause mortality,non-fatal myocardial infarction,non-fatal cerebrovascular events and target vessel revascularization rates were 6. 59%,0. 55%,0. 55% and 15. 93% respectively,the incidence of all MACCE was 23.63%. A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI. According to the multivariate-adjusted Cox regression analysis,diameter of left main stent（HR = 0.37,95% CI： 0. 17-0. 82,P = 0. 014）,bifurcation lesion（HR = 1. 92,95% CI： 1. 01-3. 62,P = 0. 045）,smoking index 50 pack/year（HR = 3. 78; 95% CI： 1. 29-11. 05,P = 0. 015） were the independent risk factors of MACCE. Euro SCOREⅡ≥2%（HR =3. 96,95% CI： 1. 15-13. 61,P = 0. 029） was the independent risk factor of all-cause death. Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable. Most MACCEs occurred in the first 2 years after the PCI. Small left main stents diameter,bifurcation lesions,smoking index 〉50 pack/year and Euro SCORE Ⅱ≥2% were the risk factors for poor prognosis in patients with ULMCA disease.

关 键 词：无保护左主干病变 经皮冠状动脉介入治疗 支架 分叉部病变 EUROSCORE Ⅱ 

分 类 号：R541.4[医药卫生—心血管疾病]