冠状动脉造影评估的靶病变钙化程度对接受经皮冠状动脉介入治疗患者手术即刻成功率和长期预后的影响  

Impact of Target Lesion Calcification Evaluated by Coronary Angiography on Immediate Procedure Success Rate and Long-term Prognosis in Patients Underwent Percutaneous Coronary Intervention

作　　者：杨敏[1,2] 林章宇 丰雷[1,2] 朱成刚[1,2] 尹栋[1,2] 杨跃进[1,2] 窦克非[1,2,3,4] YANG Min;LIN Zhangyu;FENG Lei;ZHU Chenggang;YIN Dong;YANG Yuejin;DOU Kefei(Cardiometabolic Medicine Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,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,阜外医院心血管代谢中心,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,北京100037 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心血管疾病国家重点实验室,北京100037 [4]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院国家心血管疾病临床医学研究中心,北京10003

出　　处：《中国循环杂志》2023年第12期1239-1245,共7页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(CIFMS-2021-I2M-1-008)。

摘　　要：目的:分析冠状动脉造影评估的靶病变钙化程度对接受经皮冠状动脉介入治疗(PCI)患者手术即刻成功率与长期预后的影响。方法:连续选取2017年1月至2018年12月在中国医学科学院阜外医院行PCI的前瞻性队列中有冠状动脉造影评估靶病变钙化病变程度的26712例患者数据进行分析,按靶病变钙化病变程度将患者分为4组,包括无钙化组(n=14387)、轻度钙化组(n=8231)、中度钙化组(n=3208)和重度钙化组(n=886)。主要术后即刻终点为PCI成功,定义为术后残余狭窄<50%且无主要操作并发症(包括冠状动脉穿孔、冠状动脉夹层、术中支架内血栓形成、介入器械穿入失败)。主要长期临床终点事件为3年主要不良心血管事件(MACE),包括全因死亡、心肌梗死(MI)及再次血运重建在内的复合终点事件。结果:重度钙化组较无钙化组、轻度钙化组、中度钙化组具有更低的PCI即刻成功率(80.59%vs.94.23%vs.94.29%vs.91.49%),更高的术后残余狭窄≥50%发生率(17.72%vs.5.03%vs.4.84%vs.7.29%)、冠状动脉夹层发生率(1.81%vs.0.66%vs.0.78%vs.1.25%)、冠状动脉穿孔发生率(2.14%vs.0.51%vs.0.38%vs.0.69%)及介入器械穿越失败发生率(0.23%vs.0.12%vs.0.04%vs.0.16%),差异均有统计学意义(P均<0.05)。多因素Cox回归分析显示,重度钙化组较无钙化组具有更高的MACE(12.98%vs.9.35%;HR=1.21,95%CI:1.00~1.47,P=0.046)、全因死亡(4.29%vs.1.80%;HR=1.55,95%CI:1.10~2.18,P=0.013)以及MI发生风险(2.14%vs.0.97%;HR=1.97,95%CI:1.21~3.20,P=0.006)。结论:冠状动脉造影提示具有重度钙化靶病变患者在接受PCI后,其介入治疗未成功率、MACE、全因死亡、MI发生风险均高于无钙化患者。Objectives:To analyze the impact of target lesion calcification evaluated by coronary angiography on immediate procedure success rate and long-term clinical outcome in patients underwent percutaneous coronary intervention(PCI).Methods:Consecutive patients received angiographic calcification evaluation and underwent PCI in Fuwai Hospital,Chinese Academy of Medical Sciences from January 2017 to December 2018 were prospectively enrolled in this study.Patients are divided into 4 groups,including non-calcification group(n=14387),mild calcification group(n=8231),moderate calcification group(n=3208)and severe calcification group(n=886).The primary endpoint was immediate post-PCI procedure success rate,which was defined as residual stenosis<50%without major operational complications(including coronary artery perforation,coronary artery dissection,intraoperative stent thrombosis)and failure to cross the lesion.The long-term clinical endpoint was the 3-year major adverse cardiovascular events(MACE),which included composite endpoint events such as all cause death,myocardial infarction(MI),and revascularization.Results:The severe calcification group had a lower success rate of interventional therapy(80.59%vs.94.23%vs.94.29%vs.91.49%),a higher incidence of residual stenosis≥50%(17.72%vs.5.03%vs.4.84%vs.7.29%),a higher incidence of coronary artery dissection(1.81%vs.0.66%vs.0.78%vs.1.25%),and a higher incidence of coronary artery perforation(2.14%vs.0.51%vs.0.38%vs.0.69%),and a higher incidence of failure to cross the lesion(0.23%vs.0.12%vs.0.04%vs.0.16%)compared to the non-calcification group,mild calcification group,and moderate calcification group(all P<0.05).Multivariate Cox regression analysis showed that patients with severe calcification had a higher risk of MACE(12.98%vs.9.35%,HR=1.21,95%CI:1.00-1.47,P=0.046),all-cause mortality(4.29%vs.1.80%,HR=1.55,95%CI:1.10-2.18,P=0.013),and MI(2.14%vs.0.97%,HR=1.97,95%CI:1.21-3.20,P=0.006)compared to patients without calcification.Conclusions:Patients with angiographic-detected

关 键 词：冠状动脉造影 钙化病变 经皮冠状动脉介入治疗 长期预后 

分 类 号：R54[医药卫生—心血管疾病]