冠状动脉病变分型与冠状动脉非靶病变进展和血运重建的关系  

Impacts of Lesion Classification on the Progression and Revascularization of Coronary Non-target Lesions in Patients With Coronary Heart Disease

作　　者：闫森 许浩博 黄晓青 张海鹏 陈纪林 乔树宾 崔锦钢 高立建 党爱民 管常东 张炜 李佐治 王娟 YAN Sen;XU Haobo;HUANG Xiaoqing;ZHANG Haipeng;CHEN Jilin;QIAO Shubin;CUI Jingang;GAO Lijian;DANG Aimin;GUAN Changdong;ZHANG Wei;LI Zuozhi;WANG Juan(Department of Cardiology,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、阜外医院心内科,北京100037

出　　处：《中国循环杂志》2024年第12期1170-1176,共7页Chinese Circulation Journal

摘　　要：目的:研究冠状动脉(冠脉)病变分型与冠心病患者冠脉非靶病变进展和血运重建的关系。方法:回顾性分析中国医学科学院阜外医院2010年1月至2014年9月期间,接受连续2次冠脉造影检查且造影发现冠脉非靶病变的冠心病患者1255例。患者均在第1次冠脉造影时记录到了至少1处冠脉非靶病变,所有患者均在2年内完成2次冠脉造影检查,非靶病变根据美国心脏病学会/美国心脏协会(ACC/AHA)冠脉病变分型分为A/B1型病变,B2/C型病变,依据患者非靶病变是否有B2/C型病变分为无B2/C型病变(简单病变组)和有B2/C型病变(复杂病变组)。记录所有冠脉非靶病变的特征和定量冠脉造影结果并进行前后2次对比,判断冠脉非靶病变是否进展,并记录患者的血运重建情况。结果:共纳入1255例患者,男性1003例(79.9%),年龄(58.0±9.7)岁。其中简单病变组402例,复杂病变组853例;共有1670处非靶病变,其中A/B1型病变619处(A型病变214处,B1型病变405处)和B2/C型病变1051处(B2型病变796处,C型病变255处)。随访(14.8±4.5)个月。与简单病变组相比,复杂病变组年龄较大,冠心病家族史及合并脑卒中病史比例均较低(P均<0.05)。复杂病变组患者基线白细胞计数、C反应蛋白、血沉、甘油三酯、糖化血红蛋白水平均较简单病变组高(P均<0.05)。复杂病变组的非靶病变进展比例(21.8%vs.13.2%,P<0.001)和非靶病变血运重建比例(16.5%vs.11.2%,P=0.013)均高于简单病变组。两组的非靶病变相关心肌梗死发生率的差异无统计学意义(P>0.05)。在病变水平,复杂病变组较简单病变组非靶病变进展比例更高(17.4%vs.11.0%,P<0.001),非靶病变血运重建比例更高(13.0%vs.9.2%,P=0.018)。多因素Cox回归分析显示,B2/C型病变是非靶病变进展(HR=1.732,95%CI:1.275~2.351,P<0.001)和非靶病变血运重建(HR=1.477,95%CI:1.053~2.070,P=0.024)的独立影响因素。结论:冠脉非靶病变B2/C型病变的进展风险更Objectives:To investigate the impacts of American College of Cardiology/American Heart Association(ACC/AHA)coronary artery classification on the progression of coronary non-target lesions and revascularization in patients with coronary heart disease.Methods:From January 2010 to September 2014,1255 patients who underwent two consecutive coronary angiographies at Fuwai Hospital and had coronary non-target lesions were retrospectively analyzed.Lesion characteristics of all coronary non-target lesions were recorded at both procedures.All non-target lesions were divided into A,B1,B2 and C lesion group according to ACC/AHA coronary artery classification.Patients were divided into non-B2/C lesion group(noncomplex lesion group)and B2/C lesion group(complex lesion group)according to whether the non-target lesion had B2/C lesion The characteristics of all non-target coronary artery lesions and quantitative coronary angiography results were recorded.Lesion progression and revascularization were compared between different groups.Results:There were 1003(79.9%)male patients,mean age was(58.0±9.7)years old,and 853 patients had B2/C lesions.There were 1670 non-target lesions,including 619 A/B1 lesions(214 A lesions and 405 B1 lesions)and 1051 B2/C lesions(796 B2 lesions and 255 C lesions).Follow-up time was(14.8±4.5)months.Compared with the patients in noncomplex lesion group,patients in complex lesion group were older,had lower proportion of family history of coronary heart disease and stroke(all P<0.05).The baseline levels of leukocytes,C-reactive protein,erythrocyte sedimentation rate(ESR),triglyceride and HbA1c were higher in complex lesion group than those in noncomplex lesion group.Complex lesion group had higher risk of lesion progression(21.8%vs.13.2%,P<0.001)compared with noncomplex lesion group,similar results were observed in revascularization(16.5%vs.11.2%,P=0.013),and there was no statistically difference in non-target lesion related myocardial infarction(P>0.05).At the lesion level,compared with A/B1 lesion,B2/C

关 键 词：美国心脏病学会/美国心脏协会冠状动脉病变分型 冠状动脉非靶病变 病变进展 血运重建 

分 类 号：R54[医药卫生—心血管疾病]