SYNTAX评分中分区冠状动脉粥样硬化性心脏病患者行经皮冠脉介入术治疗远期预后的性别差异  

Sex difference in long-term outcomes after percutaneous coronary intervention for patients with intermediate SYNTAX score

作　　者：傅明炜[1,2] 王热华[1,2] 陈威[1,2] 郭延松[1,2] Fu Mingwei;Wang Rehua;Chen Wei;Guo Yansong(Shengli Clinical College of Fujian Medical University,Fuzhou 350001,China;Department of Cardiology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院心内科,福州350001

出　　处：《创伤与急诊电子杂志》2020年第4期170-176,182,共8页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨SYNTAX评分中分区冠状动脉粥样硬化性心脏病(以下简称“冠心病”)患者行经皮冠脉介入术(percutaneous coronary intervention,PCI)治疗5年随访结果的性别差异。方法选取2013年1月至12月于福建省立医院就诊的SYNTAX评分中分区并行PCI治疗的64例冠心病患者为研究对象。比较女性(18例)与男性(46例)患者的临床特征及5年时的随访结果。主要终点:主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)包括全因死亡、卒中、非致死性心肌梗死及再次血运重建的总体发生率。次要终点:全因死亡、卒中、非致死性心肌梗死和再次血运重建等各类事件的发生率。结果女性患者术前SYNTAX评分低于男性患者,CRUSADE评分高于男性患者,冠状动脉三支血管病变率及术后完全血运重建率均低于男性患者,住院费用低于男性患者(均P<0.05)。5年时的主要终点MACCE发生率女性为27.8%,男性为43.5%,两组比较差异无统计学意义(χ^2=0.899,P=0.343,HR=0.627,95%CI:0.263~1.494)。调整了临床混杂因素后,P=0.833,HR=0.888,95%CI:0.295~2.673。次要终点各组分两组比较差异均无统计学意义(P>0.05)。Cox回归分析示性别不是5年MACCE的独立预测因素,冠状动脉合并左主干病变为5年MACCE的独立预测因素(P=0.020,HR=4.070,95%CI:1.242~13.341)。结论SYNTAX评分中分区冠心病患者行PCI治疗,5年时的MACCE事件发生率无性别差异。Objective To investigate sex difference in five-year follow-up outcomes after percutaneous coronary intervention(PCI)for patients with intermediate SYNTAX score.Methods We analyzed the data of 64 patients undergoing PCI with intermediate SYNTAX score from January to December 2013.Clinical features and five-year follow-up outcomes were compared between women(n=18)and men(n=46).The primary endpoint was the overall incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)at five years,defined as the four-component composite of all-cause-mortality,stroke,non-fatal myocardial infarction and repeat revascularization.The secondary endpoints included incidence of all-causemortality,stroke,non-fatal myocardial infarction and repeat revascularization.Results Compared to men,CRUSADE risk score was higher in women,while the preoperative SYNTAX score was lower,three-vessel lesion rate of coronary artery and total revascularization rate after operation were lower,and the hospitalization cost was less in women(P﹤0.05).The primary endpoints at five years occurred in 27.8% of the women and 43.5%of the men,and the difference was not statistically significant(crude χ^2=0.899,HR=0.627,95%CI:0.263-1.494;P=0.343 vs.HR=0.888,95%CI:0.295-2.673;P=0.833 after adjustment for clinical confounding variables).There was no statistically significant difference between women and men in the secondary endpoints(P﹥0.05).Cox regression analysis showed gender was not an independent predictor of fiveyear MACCE,but left main coronary artery disease was.Conclusion There was no significant difference between women and men with respect to the rate of MACCEs at five years after percutaneous coronary intervention.

关 键 词：冠状动脉粥样硬化性心脏病 SYNTAX评分 经皮冠脉介入术 性别 预后 

分 类 号：R541.4[医药卫生—心血管疾病]