| 老年左主干病变患者介入治疗预后及影响因素 |
| 投稿时间：2017-06-29 修订日期：2017-08-19 点此下载全文 |
| 引用本文：高野,邹宜覃,王倩.老年左主干病变患者介入治疗预后及影响因素[J].医学研究杂志,2018,47(4):94-99 |
| DOI：
10.11969/j.issn.1673-548X.2018.04.024 |
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| 基金项目:第二军医大学本科学员创新能力孵化基地基金资助项目（FH2016128） |
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| 中文摘要:目的 探讨老年无保护左主干（ULMCA）病变患者介入治疗预后及不良事件危险因素。方法 入选单中心年龄≥60岁行PCI治疗的ULMCA病变患者，收集基线资料并随访。记录随访中发生的主要不良心脑血管事件（MACCE），绘制Kapaln-Meier曲线，并采用Cox回归法分析不良预后的影响因素。结果 共182例完成随访，中位随访时间21.5（13，36.5）个月，无MACCE中位生存时间为66个月。共发生MACCE43例（23.63%），其中死亡12例（6.59%）、非致死性心肌梗死1例（0.55%）、非致死性脑血管意外1例（0.55%）、靶血管血运重建29例（15.93%），72.09%的MACCE发生在术后2年内。多因素校正的Cox回归分析显示：左主干支架直径（HR=0.37，95% CI：0.17~0.82，P=0.014）、分叉部病变（HR=1.92，95% CI：1.01~3.62，P=0.045）、吸烟指数>1000年支（HR=3.78，95% CI：1.29~11.05，P=0.015）是MACCE的独立危险因素；EuroSCORE Ⅱ≥2%（HR=3.96，95% CI：1.15~13.61，P=0.029）是全因死亡的独立危险因素。结论 老年ULMCA病变患者PCI术后总体预后良好，但术后2年内需特别警惕MACCE发生。左主干支架直径较小、左主干分叉部受累、吸烟指数>1000年支、EuroSCORE Ⅱ≥2%者预后较差。 |
| 中文关键词:无保护左主干病变 经皮冠状动脉介入治疗 支架 分叉部病变 EuroSCORE Ⅱ |
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| Prognosis and Risk Factors of PCI-treated Senile Patients with Unprotected Left Main Coronary Artery Disease: A Follow-up Study |
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| Abstract:Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery (ULMCA) disease treated with PCI. Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study.All patients were older than 60. The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up. All the major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated throughout the follow-up period. Based on those data, Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors. Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5 (13, 36.5) months and an estimated median MACCE-free survival time of 66 months by K-M method. During the follow up, all-cause mortality, non-fatal myocardial infarction, non-fatal cerebrovascular events and target vessel revascularization rates were 6.59%, 0.55%, 0.55% and 15.93% respectively, the incidence of all MACCE was 23.63%. A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI. According to the multivariate-adjusted Cox regression analysis, diameter of left main stent (HR=0.37, 95%CI:0.17-0.82,P=0.014), bifurcation lesion (HR=1.92,95%CI:1.01-3.62,P=0.045), smoking index> 50 pack/year (HR=3.78; 95%CI:1.29-11.05, P=0.015) were the independent risk factors of MACCE. EuroSCOREⅡ ≥ 2% (HR=3.96, 95%CI:1.15-13.61, P=0.029) was the independent risk factor of all-cause death. Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable. Most MACCEs occurred in the first 2 years after the PCI. Small left main stents diameter, bifurcation lesions, smoking index> 50 pack/year and EuroSCORE Ⅱ ≥ 2% were the risk factors for poor prognosis in patients with ULMCA disease. |
| keywords:Unprotected left main coronary artery disease Percutaneous coronary intervention Stent Bifurcation lesion EuroSCORE II |
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