旋股外动脉降支和桡动脉行冠状动脉旁路移植治疗稳定性冠心病的预后和影响因素的倾向评分匹配分析  

Prognosis and risk factors in patients with stable coronary artery disease undergoing coronary artery bypass surgery with lateral circumflex femoral artery or radial artery:a propensity score matching analysis

作　　者：王跃堂 徐东辉 李涵 王旭[1] 王欣[1] 罗新锦[1] 王巍[1] Wang Yuetang;Xu Donghui;Li Han;Wang Xu;Wang Xin;Luo Xinjin;Wang Wei(Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Science, National Center for Cardiovascular Diseases,Peking Union Medical College, Beijing 100730, China)

机构地区：[1]北京协和医学院,中国医学科学院阜外医院结构性心脏病科,国家心血管病中心,100730

出　　处：《中国心血管杂志》2020年第3期237-242,共6页Chinese Journal of Cardiovascular Medicine

基　　金：国家重点研发计划(2016YFC1300900)。

摘　　要：目的应用倾向得分匹配法分析旋股外动脉降支(DBLCFA)和桡动脉(RA)进行体外循环下冠状动脉旁路移植治疗稳定性冠心病的预后和影响因素。方法本研究为前瞻性队列研究。收集自2017年1月至2019年6月在阜外医院行体外循环下冠状动脉旁路移植术的稳定性冠心病患者,依据倾向评分匹配法按1∶3选取52例应用旋股外动脉作为桥血管的患者作为DBLCFA组和156例应用桡动脉作为桥血管的患者作为RA组,随访截止时间为2019年12月31日,比较两组的临床资料,Kaplan-Meier生存分析和log-rank检验比较两组的桥血管通畅率和不良心血管事件(MACE)发生率,单因素和多因素Cox回归分析影响预后的危险因素。结果208例稳定性冠心病患者中,平均年龄(54.7±15.5)岁(40~70岁)。DBLCFA组和RA组患者的年龄、体质指数、病史和危险因素、实验室检查、冠心病严重程度等均无明显差异(均P>0.05)。Kaplan-Meier生存分析结果显示,随访1年后,DBLCFA组桥血管通畅率为96.2%(50/52),生存率为98.1%(51/52),MACE发生率为5.8%(3/52);RA组桥血管通畅率为97.4%(152/156),生存率为100.0%(156/156),MACE发生率为5.1%(8/156),两组间的桥血管通畅率(χ2=0.228,P=0.632)、存活率(χ2=3.014,P=0.083)和MACE发生率(χ2=0.032,P=0.862)均无明显差别。随访3年后,DBLCFA组桥血管通畅率为90.4%(47/52),生存率为94.2%(49/52),MACE发生率为14.3%(7/52);RA组桥血管通畅率为93.6%(146/156),生存率为98.1%(153/156),MACE发生率为10.9%(17/156)。两组间的桥血管通畅率(χ2=0.598,P=0.439)、存活率(χ2=2.059,P=0.151)和MACE发生率(χ2=0.251,P=0.8616)均无明显差别。多因素Cox回归分析结果显示,年龄(HR=2.425,95%CI:1.286~4.573,P=0.006)、EuroscoreⅡ评分(HR=2.463,95%CI:1.116~5.436,P=0.026)和糖尿病(HR=3.024,95%CI:1.427~6.408,P=0.004)是影响MACE的危险因素。结论对稳定性冠心病患者,DBLCFA作为移植血管具有较高的早中期通畅率、存活率和较低的MACE发Objective To analyze the prognosis and influencing factors of coronary artery bypass grafting by descending branch of external femoral artery(DBLCFA)and radial artery(RA)using propensity score matching method.Methods This study was a prospective cohort study.Stable coronary artery disease patients who underwent coronary artery bypass grafting at Fuwai Hospital from January 2017 to June 2019 were collected.According to the propensity score matching method by 1∶3,52 patients who used the external femoral artery as the bridge vessel were selected as the DBLCFA group and 156 patients using the radial artery as the bridge vessel were used as the RA group.The follow-up deadline was December 31,2019.The clinical data of the two groups were compared.Kaplan-Meier survival analysis and log-rank test were used to compare the bridge between the two groups.Vascular patency rate and incidence of adverse cardiovascular events,and univariate and multivariate Cox regression analysis of risk factors affecting prognosis.Results Among the 208 patients with stable coronary artery disease,the mean age was 54.7±15.5 years(40 to 70 years).There were no significant differences in age,body mass index,history and risk factors,laboratory tests,and severity of coronary heart disease between the DBLCFA group and the RA group(all P>0.05).Kaplan-Meier survival analysis showed that after 1 year of follow-up,the vascular patency rate of bridge vessels in the DBLCFA group was 96.2%(50/52),the survival rate was 98.1%(51/52),and the incidence of MACE was 5.8%(3/52);and RA vessel patency rate was 97.4%(152/156),survival rate was 100.0%(156/156),MACE incidence rate was 5.1%(8/156),bridge vessel patency rate between the two groups(χ2=0.228,P=0.632),survival rate(χ2=3.014,P=0.083),and MACE incidence rate(χ2=0.032,P=0.862)were not significantly different.After 3 years of follow-up,the vascular patency rate of the bridge vessels in the DBLCFA group was 90.4%(47/52),the survival rate was 94.2%(49/52),and the incidence of MACE was 14.3%(7/52).The surv

关 键 词：稳定性冠心病 旋股外动脉降支 桡动脉 冠状动脉旁路移植 倾向评分匹配方法 

分 类 号：R54[医药卫生—心血管疾病]