临床表型对冠状动脉病变低危患者介入治疗远期预后的影响  

Outcome of Patients With SYNTAX Score ≤22 Post Percutaneous Coronary Intervention:Gender Differences and Association With Clinical Phenotype

作　　者：陈艳[1] 宋莹[1] 赵雪燕[1] 高立建[1] 陈珏[1] 张茵[1] 高展[1] 宋雷[1] 杨跃进[1] 高润霖[1] 乔树宾[1] 徐波[1] 袁晋青[1] CHEN Yan;SONG Ying;ZHAO Xueyan;GAO Lijian;CHEN Jue;ZHANG Yin;GAO Zhan;SONG Lei;YANG Yuejin;GAO Runlin;QIAO Shubin;XU Bo;YUAN Jinqing(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心内科,100037

出　　处：《中国循环杂志》2021年第2期137-143,共7页Chinese Circulation Journal

基　　金：国家重点研发计划项目(2016YFC1301300,分课题2016YFC1301301)。

摘　　要：目的:探讨急性冠状动脉综合征(ACS)和稳定性冠心病(SCAD)对不同性别冠状动脉病变SYNTAX评分≤22分患者介入治疗远期预后的影响。方法:纳入2013年1月至12月在中国医学科学院阜外医院行经皮冠状动脉介入治疗(PCI)且SYNTAX评分≤22分的患者9458例。按临床表型将不同性别的患者分为ACS和SCAD患者,其中包括女性患者2169例(其中ACS 853例、SCAD 1316例),男性患者7289例(其中ACS 4404例,SCAD 2885例)。患者在术后1个月、6个月、1年和2年接受门诊或电话随访。研究主要终点为全因死亡,次要终点为心原性死亡、再发心肌梗死和主要不良心脑血管事件(MACCE,包括全因死亡、再发心肌梗死、血运重建、脑卒中和支架内血栓形成)。采用Cox比例风险回归模型分析PCI后2年远期预后的影响因素。结果:PCI后2年,女性ACS患者全因死亡[1.7%(23/1316)vs.0.6%(5/853),log-rank P=0.004]、心原性死亡[1.0%(13/1316)vs.0.2%(2/853),log-rank P=0.011]的发生率均高于女性SCAD患者,而再发心肌梗死和MACCE两者的差异无统计学意义。男性ACS和SCAD患者远期预后差异无统计学意义。多因素Cox回归分析显示,ACS是SYNTAX评分≤22分的女性患者PCI后2年全因死亡(HR=3.27,95%CI:1.05~10.18,P=0.041),心原性死亡(HR=16.63,95%CI:1.49~185.91,P=0.022)的独立危险因素。结论:在接受PCI SYNTAX评分≤22分的患者中,女性ACS患者2年全因死亡和心原性死亡明显高于SCAD,而男性ACS与SCAD患者2年预后相似。Objectives:To investigate the outcome of patients with SYNTAX score≤22 and treated with percutaneous coronary intervention(PCI)and explore the impact of gender and association with clinical phenotype.Methods:A total of 9458 patients,who underwent PCI with SYNTAX score≤22,were consecutively enrolled throughout 2013.There were 2169 female patients(ACS:853,SCAD:1316)and 7289 male patients(ACS:4404,SCAD:2885).Patients were followed up at 1,6,12 and 24 months post PCI by clinical outpatient visit or telephone interview.The primary endpoint was all-cause death,the secondary endpoints included cardiac death,recurrent myocardial infarction and major adverse cardio-cerebrovascular events(MACCEs,including all-cause death,recurrent myocaridal infarction,repeated revascularization,stroke and in-stent thrombosis).Outcomes were compared according to gender and the clinical phenotype(acute coronary syndrome[ACS]or stable coronary disease[SCAD]).Multivariate Cox regression analysis was used to identify independent risk factors of poor prognosis.Results:The 2-year follow-up results showed that the incidences of all-cause death(1.7%[23/1316]vs.0.6%[5/853],log rank P=0.004)and cardiac death(1.0%[13/1316]vs.0.2%[2/853],log rank P=0.011)were significantly higher in female ACS group than in female SCAD group.The incidences of all-cause death and cardiac death were similar between male ACS and male SCAD groups(P>0.05).Multivariate Cox regression analysis showed that ACS was an independent risk factor of all-cause death(HR=3.27,95%CI:1.05-10.18,P=0.041)and cardiac death(HR=16.63,95%CI:1.49-185.91,P=0.022)in female patients with SYNTAX score≤22.Conclusions:ACS is an independent risk factor of 2-year all-cause death and cardiac death post PCI in female patients with SYNTAX score≤22.

关 键 词：急性冠状动脉综合征 稳定性冠心病 性别 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]