无保护左主干开口/体部病变经皮冠状动脉介入术的长期预后及危险因素分析  

Long-term outcomes and risk factors of ostial/shaft lesions in unprotected left main coronary artery after percutaneous coronary intervention

作　　者：玉献鹏[1] 曾勇 李宇[1] 吴长燕[1] 何继强[1] 罗亚玮[1] Yu Xianpeng;Zeng Yong;Li Yu;Wu Changyan;He Jiqiang;Luo Yawei(Department of Cardiology,Beijing An Zhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中华医学杂志》2021年第11期782-785,共4页National Medical Journal of China

摘　　要：目的本研究旨在观察经皮冠状动脉介入术(PCI)治疗无保护左主干开口/体部患者长期预后及其危险因素。方法入选2003年1月至2009年7月北京安贞医院行PCI治疗的无保护左主干开口/体部病变组271例。研究终点包括全因死亡、心肌梗死、卒中、再次血运重建。采用Cox比例风险模型对PCI治疗无保护左主干开口/体部病变死亡率进行生存分析,并对全因死亡进行多因素校正分析。结果271例患者年龄(62±10)岁,男性201例(74.2%),随访时间[M(Q1,Q3)]12.5(10.1,14.5)年,在左主干开口/体部病变患者中,46例患者死亡(17.0%),20例为心源性死亡(7.4%),共38例发生心肌梗死(14.0%),15例发生卒中(5.5%),63例患者再次血运重建(23.2%)。年龄(HR=1.041,95%CI:1.003~1.081,P=0.033)、肌酐(HR=1.028,95%CI:1.014~1.042,P<0.001)、糖尿病(HR=1.924,95%CI:1.053~3.514,P=0.033)是无保护左主干开口/体部病变行PCI术后全因死亡的独立危险因素,左室射血分数(HR=0.972,95%CI:0.953~0.992,P=0.007)是无保护左主干开口/体部病变行PCI术后全因死亡的保护因素。结论在中位数长达12.5年的随访中,PCI治疗无保护左主干开口/体部患者长期预后尚可,年龄、血肌酐、糖尿病是全因死亡的独立危险因素。Objective To evaluate the long-term clinical outcomes after percutaneous coronary intervention(PCI)with drug-eluting stents(DES)for ostial/shaft lesions in patients with unprotected left main coronary artery(ULMCA).Method A total of 271 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery who received drug-eluting stents(DES)implantation between January 2003 and July 2009 in Beijing An Zhen Hospital were consecutively enrolled.The endpoints of the study were all-cause death,repeat revascularization,myocardial infarction(MI)and stroke.Cox regression was carried out to analyze the all-cause mortality.Meanwhile,multivariate logistic regression analysis was performed to determine the independent risk factors of all-cause death.Results The mean age of the patients was(62±10)years,and 201 of them(74.2%)were male.The median follow-up was 12.5 years(interquartile range:10.1-14.5 years).During the follow-up,46 patients(17.0%)died,of whom 20(7.4%)died of a cardiovascular cause.A total of 38(14.0%)cases suffered a MI,and 15(5.5%)cases suffered a stroke.Repeat revascularization was performed in 63(23.2%)cases.Multivariate logistic regression analysis showed that age(HR=1.041,95%CI:1.003-1.081,P=0.033),creatinine(HR=1.028,95%CI:1.014-1.042,P<0.001)and diabetes mellitus(HR=1.924,95%CI:1.053-3.514,P=0.033)were independent risk factors of all-cause death,whereas left ventricular ejection fraction(LVEF)(HR=0.972,95%CI:0.953-0.992,P=0.007)was a protective factor.Conclusions During a median follow-up of 12.5 years,the prognosis of PCI for left main ostium/shaft lesion was good.Age,creatinine and diabetes mellitus are independent risk factors of all-cause death.

关 键 词：经皮冠状动脉介入治疗 冠心病 预后 

分 类 号：R541.4[医药卫生—心血管疾病]