急性冠状动脉综合征患者经皮冠状动脉介入治疗术后6个月内再入院危险因素分析  

Risk factors for readmission in patients with acute coronary syndrome within 6 months after percutaneous coronary intervention

作　　者：尉驰 袁平年 郭文怡 Wei Chi;Yuan Pingnian;Guo Wenyi(Department of Cardiology, First Affiliated Hospital of Air Force Military Medical University, Xi'an 710032, China;Department of Cardiology, Third People's Hospital of Xi'an, Xi'an 710032, China)

机构地区：[1]空军军医大学第一附属医院心内科,西安710032 [2]西安市第三人民医院心内科,西安710032

出　　处：《中国心血管杂志》2019年第3期218-222,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨急性冠脉综合征患者经皮冠状动脉介入治疗(PCI)后6个月内再入院的危险因素。方法本研究为回顾性病例对照研究。纳入2015年1月至2017年12月在第四军医大学西京医院接受PCI治疗的1397例急性冠状动脉综合征(ACS)患者。按照随访6个月内的住院次数分为病例组(住院≥2次)和对照组(住院1次),比较两组患者的基线临床资料。应用logistic回归分析PCI术后再住院的危险因素。结果病例组和对照组的男性比例、吸烟史、心肌梗死、心绞痛、心力衰竭、糖尿病、肌钙蛋白Ⅰ水平、心电图ST段改变、心功能、病变血管、Gensini评分、阿司匹林、替格瑞洛、血管紧张素转换酶抑制剂、利尿剂等均有明显差异(均为P<0.05)。多因素logistic回归分析结果显示:男性(OR=1.50,95%CI:1.08~2.08)、年龄>65岁(OR=1.48,95%CI:1.08~2.03)、白细胞计数>10×109/L(OR=3.03,95%CI:1.55~5.91)、多支血管病变(OR=2.83,95%CI:1.88~4.26)、糖尿病(OR=1.73,95%CI:1.21~2.47)、心电图ST段改变(OR=3.91,95%CI:2.86~5.34)和右冠状动脉病变(OR=2.07,95%CI:1.41~3.02)是ACS患者PCI术后6个月内再入院的独立危险因素。性别和年龄分层后发现,不同年龄的男性和女性的再住院危险因素不同。结论年龄和性别是影响再住院的危险因素,需结合患者的年龄和性别,对ACS患者PCI术后6个月再住院的危险因素进行具体分析。Objective To explore the risk factors for readmission in patients with acute coronary syndrome(ACS) within 6 months after percutaneous coronary intervention (PCI). Method This study is a retrospective case-control study.1 397 patients with ACS treated by PCI in Xijing Hospital of Fourth Military Medical University from January 2015 to December 2017 were enrolled.The patients were divided into case group (hospitalization for more than 2 times) and control group (hospitalization for 1 time) according to the hospitalizations within 6 months of follow-up. The baseline clinical data of the two groups were compared. Logistic regression analysis was used risk factors for re-hospitalization after PCI. Result There were significant differences in male ratio, smoking history, myocardial infarction, angina pectoris, heart failure, diabetes mellitus, troponin I level, ST segment changes of electrocardiogram, cardiac function, pathological vessels, Gensini score, aspirin, tigliol, angiotensin converting enzyme inhibitor and diuretics between the case group and the control group (all P <0.05). Multivariate logistic regression analysis showed that:male ( OR=1.50, 95%CI : 1.08-2.08), age>65 years ( OR=1.48, 95%CI : 1.08-2.03), white blood cell count >10×10 9/L( OR=3.03, 95%CI : 1.55-5.91), multiple vessel lesions( OR=2.83, 95%CI: 1.88-4.26), diabetes ( OR=1.73, 95%CI : 1.21-2.47), electrocardiographic ST segment changes ( OR=3.91,95%CI :2.86-5.34), right coronary artery lesions ( OR=2.07, 95%CI: 1.41-3.02) were independent risk factors for readmission of ACS patients within 6 months after PCI.Gender and age stratified analysis revealed that there were different risk factors for re-hospitalization between men and women with different ages. Conclusion Age and gender are the risk factors of readmission. It is necessary to analyze the risk factors for readmission in ACS patients 6 months after PCI according to the age and gender of patients.

关 键 词：急性冠状动脉综合症 血管成形术 经皮 经冠状动脉 再入院 

分 类 号：R541.4[医药卫生—心血管疾病]