| 132 | 11 | 47 |
| 下载次数 | 被引频次 | 阅读次数 |
目的评估不同血运重建程度对老年冠心病合并糖尿病患者临床预后的影响。方法选择接受PCI的冠心病合并糖尿病患者1055例,根据血运重建程度分为完全性血运重建(CR)组261例[SYNTAX血运重建指数(SRI)100%],非CR1组385例(SRI 50%~99%)及非CR2组409例(SRI<50%)。观察3组随访2年心血管事件发生情况,并根据ROC曲线计算约登指数,找到临床最佳血运重建程度截点。结果 3组随访2年主要不良心血管事件(MACE)、心绞痛、死亡、心源性死亡、心肌梗死、非计划血运重建比较,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,SRI是老年冠心病合并糖尿病患者PCI术后2年MACE的保护因素,其中合理的SRI可以使2年MACE发生风险降低64%(P=0.010)。SRI对MACE有很高的预测价值,ROC曲线下面积为0.65,最大约登指数为0.291,血运重建程度最佳截点为65%。结论老年冠心病合并糖尿病患者CR随访2年心血管事件更低。对不能进行CR患者应尽可能使血运重建程度达到65%以上,以降低长期随访病死率。
Abstract：Objective To assess the effect of revascularization on clinical outcome in elderly CHD patients with DM undergoing PCI.Methods 1055 CHD patients with DM undergoing PCI were divided into complete revascularization(CR)group(n=261),non-CR group 1(n=385)and nonCR group 2(n=409).The patients were followed up for 2 years during which the cardiovascular events were recorded.The SYNTAX revascularization index(SRI)was calculated according to the ROC curve and the best prognostic accuracy of revascularization was assayed.Results A significant difference was found in the incidence of MACE,angina pectoris,motality,cardiogenic death,myocardial infarction,unplanned revascularization during the 2-year follow-up period(P<0.05,P<0.01).Logistic regression analysis showed that SRI was a protective factor for MACE,reduced 64% of MACE,and thus played a great role in predicting the incidence of MACE in elderly CHD patients with DM after 2 years of PCI(P=0.010).The area under the ROC curve showed the best prognostic accuracy of revascularization was 65%.Conclusion The incidence of cardiovascular events is low in elderly CHD patients with DM after 2 years of CR.The revascularization rate should be higher than 65% for those who cannot undergo CR in order to reduce their mortality during the long-term follow-up period.
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(6):521-528.DOI:10.3969/j.issn.1000-3614.2016.06.001.
[2]Dangas GD,Claessen BE,Caixeta A,et al.In-stent restenosis in the drug-eluting stent era[J].J Am Coll Cardiol,2010,56(23):1897-1907.DOI:10.1016/j.jacc.2010.07.028.
[3]Tebaldi M,Campo G,Biscaglia S.Fractional flow reserve:current applications and overview of the available data[J].World J Clin Cases,2015,3(8):678-681.DOI:10.12998/wjcc.v3.i8.678.
[4]郭永和,周玉杰,赵迎新,等.不完全血运重建策略对老年冠状动脉多支血管病变患者预后的影响[J].中国介入心脏病学杂志,2012,20(1):9-11.DOI:10.3969/j.issn.1004-8812.2012.01.004.
[5]Généreux P,Campos CM,Yadav M,et al.Reasonable incomplete revascularisation after percutaneous coronary intervention:the SYNTAX revascularisation index[J].Euro Intervention,2015,11(6):634-642.DOI:10.4244/EIJY14M10_05.
[6]Farooq V,Girasis C,Magro M,et al.The CABG SYNTAX score-an angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery:from the SYNTAX Left Main Angiographic(SYNTAX-LE MANS)substudy[J].Euro Intervention,2013,8(11):1277-1285.DOI:10.4244/EIJV8I11A196.
[7]De Bruyne B.Multivessel disease:from reasonably incomplete to functionally complete revascularization[J].Circulation,2012,125(21):2557-2559.DOI:10.1161/CIRCULATIONAHA.112.106872.
[8]Zreik M,Lessmann N,van Hamersvelt RW,et al.Deep learning analysis of the myocardium in coronary CT angiography for identification of patients with functionally significant coronary artery stenosis[J].Med Image Anal,2017,44:72-85.DOI:10.1016/j.media.2017.11.008.
[9]Parikh V,Agnihotri K,Kadavath S,et al.Clinical application of fractional flow reserve-guided percutaneous coronary intervention for stable coronary artery disease[J].Curr Cardiol Rep,2016,18(4):32.DOI:10.1007/s11886-016-0711-3.
[10]Kobayashi Y,Nam CW,Tonino PA,et al.The prognostic value of residual coronary stenoses after functionally complete revascularization[J].J Am Coll Cardiol,2016,67(14):1701-1711.DOI:10.1016/j.jacc.2016.01.056.
[11]van Nunen LX,Zimmermann FM,Tonino PA,et al.Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease(FAME):5-year follow-up of a randomised controlled trial[J].Lancet,2015,386(10006):1853-1860.DOI:10.1016/S0140-6736(15)00057-4.
[12]Hoole SP,Seddon MD,Poulter RS,et al.Fame comes at a cost:a Canadian analysis of procedural costs in use of pressure wire to guide multivessel percutaneous coronary intervention[J].Can J Cardiol,2011,27(2):262.DOI:10.1016/j.cjca.2010.12.019.
基本信息:
中图分类号:R541.4;R587.1
引用信息:
[1]白静,于一,王严,等.血运重建程度对老年冠心病合并糖尿病患者经皮介入治疗术后临床预后的影响[J].中华老年心脑血管病杂志,2018,20(03):229-233.
基金信息:
国家重点研发计划“精准医学研究”重点专项(2017YFC0908800);; 北京市医院管理局“登峰”计划(DFL20150601);北京市医院管理局临床医学发展专项(ZYLX201303,XMLX201601);; 国家临床重点专科建设项目(2013-2014年度)
2018-03-20
2018-03-20
2018-03-20