冠心病多支病变患者同期和分期经皮冠状动脉介入疗法对远期预后的影响  

Long-term prognosis effects of single and staged percutaneous coronary intervention in patients with multi-vessel coronary artery disease

作　　者：马元良 徐娜[2] 尹春琳[1] 姚懿[2] 唐晓芳[2] 贾斯达 张策[2] 宋莹[2] 许晶晶[2] 赵雪燕[2] 张茵[2] 陈珏[2] 杨跃进[2] 乔树宾[2] 高润霖[2] 徐波[2] 袁晋青[2] Ma Yuanliang;Xu Na;Yin Chunlin;Yao Yi;Tang Xiaofang;Jia Sida;Zhang Ce;Song Ying;Xu Jingjing;Zhao Xueyan;Zhang Yin;Chen Jue;Yang Yuejin;Qiao Shubin;Gao Runlin;Xu Bo;Yuan Jinqing(Department of Cardiology,Xuanwu Hospital Capital Medical University,Beijing 100053,China;Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]首都医科大学宣武医院心脏内科,北京100053 [2]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,北京100037

出　　处：《中国医师进修杂志》2022年第1期6-13,共8页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较同期和分期经皮冠状动脉介入疗法(PCI)对冠心病多支病变患者长期预后的影响。方法采用前瞻性的研究方法,选取2013年1—12月中国医学科学院阜外医院行PCI治疗的冠心病多支病变患者1832例。将患者按PCI治疗次数分为同期PCI组(1218例)和分期PCI组(614例)。随访2年,主要终点事件为主要不良心脑血管事件(MACCE),包括靶血管相关心肌梗死(TV-MI)、靶血管相关血运重建(TVR)、心源性死亡和卒中,次要终点事件为支架血栓。采用倾向性评分匹配平衡两组数据,比较两组基线资料和随访事件发生率;绘制Kaplan-Meier生存曲线,比较两组生存率;多因素Cox比例风险回归法分析分期PCI是否为终点事件的独立危险因素。结果同期PCI组住院时间、介入操作时间、术前紫杉醇药物支架经皮冠状动脉介入治疗与心脏外科手术之间的协同作用研究(SYNTAX)积分明显小于分期PCI组[(5.54±3.09)d比(9.50±4.06)d、(43.12±28.55)min比(79.54±44.35)min、(14.04±7.63)分比(18.51±7.79)分],差异有统计学意义(P<0.01);两组完全血运重建率和术后SYNTAX积分比较差异无统计学意义(P>0.05)。2年随访结果显示,分期PCI组TV-MI和支架血栓发生率高于同期PCI组[2.1%(13/614)比0.5%(6/1218)和2.0%(12/614)比0.4%(5/1218)],差异有统计学意义(P<0.01)。Kaplan-Meier生存曲线分析结果显示,同期PCI组无TV-MI和无支架血栓生存率优于分期PCI组(99.5%比97.9%和99.6%比98.0%),差异有统计学意义(P<0.01)。多因素Cox比例风险回归分析结果显示,分期PCI是支架血栓的独立危险因素(HR=3.91,95%CI 1.25~12.18,P=0.019)。倾向性评分匹配后,分期PCI组TV-MI和支架血栓发生率仍高于同期PCI组[2.1%(13/614)比0.7%(4/614)和2.0%(12/614)比0.5%(3/614)],差异有统计学意义(P<0.05);Kaplan-Meier生存曲线分析结果显示,同期PCI组无TV-MI和无支架血栓生存率仍优于分期PCI组(99.3%比97.9%和99.5%比98.0%),差异有统计学意义(Objective To compare the influence of single and staged percutaneous coronary intervention(PCI)on long-term prognosis in patients with multi-vessel coronary artery disease.Methods Using prospective research methods,1832 patients with multi-vessel coronary artery disease from January to December 2013 in Fuwai Hospital,Chinese Academy of Medical Sciences were selected.According to the time of PCI,the patients were divided into single PCI group(1218 cases)and staged PCI group(614 cases).The patients were followed up for 2 years,the primary endpoint was major cardiovascular and cerebrovascular event(MACCE),including target vessel-related myocardial infarction(TV-MI),target vessel-related revascularization(TVR),cardiogenic death and stroke,and the secondary endpoint was stent thrombosis.The propensity score matching(PSM)was applied to balance the discrepancies between 2 groups,and the baseline and follow-up data were compared.The Kaplan-Meier survival curves were drawn to evaluate the survival rates events;multifactor Cox proportional risk regression was used to analyze whether staged PCI was an independent risk factor for the endpoint events.Results The in-hospital stay,duration of procedure and synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX)score in single PCI group were significantly lower than those in staged PCI group:(5.54±3.09)d vs.(9.50±4.06)d,(43.12±28.55)min vs.(79.54±44.35)min,(14.04±7.63)scores vs.(18.51±7.79)scores,and there were statistical differences(P<0.01);there were no statistical difference in complete revascularization rate and SYNTAX score after PCI between 2 groups(P>0.05).Based on 2-year follow-up,the incidences of TV-MI and stent thrombosis in staged PCI group were significantly higher than those in single PCI group:2.1%(13/614)vs.0.5%(6/1218)and 2.0%(12/614)vs.0.4%(5/1218),and there were statistical differences(P<0.01).Kaplan-Meier survival curves analysis results showed that the event-free survival rates of TV-MI and stent thrombosis in single

关 键 词：冠状动脉疾病 心绞痛 预后 经皮冠状动脉介入疗法 

分 类 号：R541.4[医药卫生—心血管疾病]