首次不同血运重建方式对冠心病合并慢性肾功能不全患者再次行PCI治疗的影响  

Effect of first coronary artery bypass grafting on reoperative revascularization in coronary heart disease combined with chronic kidney disease patients

作　　者：张英[1] 翟光耀[2] 王建龙[2] 齐静[2] 成万钧[2] 刘宇扬[2] 周玉杰[2] Zhang Ying;Zhai Guangyao;Wang Jianlong;Qi Jing;Cheng Wanjung;Liu Yuyang;Zhou Yujie(Department of Cardiology,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]承德医学院附属医院心脏内科,067000 [2]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华胸心血管外科杂志》2020年第6期361-365,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较冠状动脉粥样硬化性心脏病(冠心病)合并慢性肾功能不全患者选择不同方式进行首次血运重建治疗后再次行PCI血运重建治疗的临床资料及预后,探讨首次血运重建时行冠状动脉旁路移植术(CABG)对患者再次PCI血运重建的影响。方法回顾性分析2008年1月至2017年12月期间358例行再次PCI血运重建治疗冠心病合并慢性肾功能不全患者的临床资料,其中男310例,女48例;年龄36~91岁,平均(65.19±10.13)岁。按照首次血运重建方式分为CABG组(75例)和经皮冠状动脉介入治疗(PCI)组(PCI组,283例)。对患者再次血运重建术后主要不良心血管事件(MACCE)发生情况进行Cox回归分析,建立风险预测模型。比较两组临床特征和预后。结果与PCI组比较,CABG组患者现症吸烟(17.33%对33.57%,P=0.006)、再发急性心肌梗死入院比例(28.00%对40.64%,P=0.045)降低,合并冠状动脉三支病变(82.67%对55.12%,P<0.001)、Gensini评分[136.00(100.75,164.00)分对53.00(39.00,74.00)分,P<0.001]、经股动脉入路行再次血运重建(49.33%对24.03%,P<0.001)和造影剂用量[300(200,400)ml对200(200,300)ml,P<0.001]明显增高,但MACCE事件发生比例低(40.00%对57.60%,χ^2=7.571,P=0.0059)。Cox回归分析结果显示,首次血运重建选择CABG(RR=0.586,95%CI:0.396~0.867,P=0.007)及更高的肾小球滤过率(RR=0.988,95%CI:0.980~0.997,P=0.007)是保护性因素;而白细胞升高(RR=1.100,95%CI:1.020~1.187,P=0.013)和使用肾素-血管紧张素-醛固酮系统抑制剂(RR=1.380,95%CI:1.016~1.875,P=0.039)是独立危险因素。结论冠心病合并慢性肾功能不全患者首次血运重建时选择CABG有益于再次血运重建患者预后。Objective By comparing the clinical data and follow-up data of patients with coronary heart disease combined with chronic kidney disease who choose different ways of revascularization for the first time when do PCI revascularization therapy again.To investigate the effect of coronary artery bypass grafting on revascularization for the first time in patients.Methods A retrospective analysis of clinical data of 358 patients with coronary heart disease combined with chronic kidney disease who received revascularization PCI from January 2008 to December 2017 was made.All the patients were divided into CABG group(75 cases)and PCI group(283 cases)for clinical characteristics and prognosis comparison.According to the occurrence of major adverse cardiovascular events,Cox regression was carried out to establish a risk prediction model.Results Compared with the patients in the two groups,the ratio of current smoking(17.33%vs.33.57%,P=0.006)and hospitalized patients with recurrent acute myocardial infarction(28.00%vs.40.64%,P=0.045)were decreased in CABG group,the ratio of triple-vessel disease(82.67%vs.55.12%,P<0.001)and road via femoral artery(49.33%vs.24.03%,P<0.001)were significantly increased in the CABG group,the Gensini score[136.00(100.75,164.00)vs.53.00(39.00,74.00),P<0.001]and contrast agent dosage[300(200,400)ml vs.200(200,300)ml,P<0.001]were significantly higher in CABG group,but the incidence of MACCE was significantly lower in CABG group than in PCI group(40.00%vs.57.60%,χ^2=7.571,P=0.0059).According to the Cox regression of MACCE events,it was found that CABG(RR=0.586,95%CI:0.396-0.867,P=0.007)and higher glomerular filtration rate(RR=0.988,95%CI:0.980-0.997,P=0.007)were the protective factors,white blood cell elevation(RR=1.100,95%CI:1.020-1.187,P=0.013)and the application of renin-angiotensin-aldosterone system inhibitor(RR=1.380,95%CI:1.016-1.875,P=0.039)were independent risk factors.Conclusion Patients with coronary heart disease combined with chronic kidney disease can benefit from CABG for the first tim

关 键 词：冠状动脉旁路移植术 慢性肾功能不全 冠状动脉粥样硬化性心脏病 再次血运重建 

分 类 号：R541.4[医药卫生—心血管疾病] R692.5[医药卫生—内科学]