老年冠心病患者PCI术后主要心脑血管不良事件发生情况及影响因素分析

时之秀; 杜训松; 曹洁

doi:10.13201/j.issn.1001-1439.2022.02.010

老年冠心病患者PCI术后主要心脑血管不良事件发生情况及影响因素分析

- 1.
  安徽省第二人民医院医院导管室(合肥，230041)
- 2.
  安徽省第二人民医院心内科

详细信息

通讯作者: 时之秀，E-mail：Cx1056@126.com

中图分类号: R541.4

收稿日期: 2021-06-26

修回日期: 2021-09-27

刊出日期: 2022-02-13

Risk factors of major adverse cardiovascular and cerebrovascular events after PCI in elderly patients with coronary heart disease

- 1.
  Catheter Room
- 2.
  Department of Cardiology, Anhui No.2 Provincial People's Hospital, Hefei, 230041, China

More Information

Corresponding author: SHI Zhixiu, E-mail: Cx1056@126.com

Received Date: 26 June 2021

Revised Date: 27 September 2021

Publish Date: 13 February 2022

摘要

摘要: 目的探讨老年冠心病患者行经皮冠状动脉介入治疗(PCI)术后中远期主要心脑血管不良事件(MACCE)发生率、临床特点以及相关危险因素。方法回顾性分析2017年1月—2019年6月于我院心血管内科行PCI治疗的330例老年冠心病患者的临床资料，术后随访患者24个月，根据是否出现MACCE将全部患者分为MACCE组和无MACCE组。将所有患者的临床资料、实验室检查及术中结果进行逐一登记作为自变量，以是否出现MACCE作为因变量。所有自变量进行组间单因素分析，然后将单因素分析有意义者进一步行非条件二分类Logistic回归分析。结果老年冠心病行PCI患者术后MACCE发生率为29.09%(96/380)。单因素分析显示年龄、糖尿病、肾功能不全、高尿酸、心功能、左主干病变、C型病变以及植入支架数量和老年冠心病患者PCI术后MACCE发生密切相关(均P< 0.05)。多因素分析显示糖尿病(OR=3.864，95%CI：1.685~6.314)、高尿酸(OR=1.755，95%CI：1.170~4.690)、左主干病变(OR=4.185，95%CI：2.173~6.755)、C型病变(OR=4.565，95%CI：2.380~6.896)、植入支架数目(≥3枚)(OR=6.038，95%CI：2.382~11.560)是老年冠心病患者PCI术后MACCE的独立危险因素。结论老年冠心病患者PCI术后中短期内MACCE的发生率较高，合并糖尿病、高尿酸、左主干病变、C型病变以及植入过多的内支架等因素能独立影响MACCE的发生。
- 冠心病 /
- 经皮冠状动脉介入治疗 /
- 主要心脑血管事件 /
- 危险因素
Abstract: Objective To investigate the clinical characteristics, incidence, and related risk factors of major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease.Methods A total of 330 elderly patients with coronary heart disease after PCI, were selected in the cardiovascular department of our hospital from Jan. 2017 to Jun. 2019. They were followed up for 24 months after the operation. All patients were divided into MACCE group and MACCE free group. The clinical data, laboratory examinations, and intraoperative results of all patients were registered as independent variables, the presence of MACCE was used as the dependent variable. All independent variables were analyzed by univariate analysis, and those with significant univariate analysis were further analyzed by unconditional binary logistic regression.Results The incidence of MACCE was 29.09% (96/330) in elderly patients with coronary heart disease after PCI. Univariate analysis showed that age, diabetes, renal insufficiency, hyperuric acid, cardiac function, left main disease, C-type disease, and the number of implanted stents were closely related to the occurrence of MACCE in elderly patients with coronary heart disease after PCI (allP< 0.05). Multivariate analysis showed that diabetes mellitus (OR=3.864, 95%CI: 1.685-6.314), high uric acid (OR=1.755, 95%CI: 1.170-4.690), left main lesion (OR=4.185, 95%CI: 2.173-6.755), C lesion (OR=4.565, 95%CI: 2.380-6.896), and the number of stent implantation (≥3) (OR=6.038, 95%CI: 2.382-11.560) were independent risk factors of MACCE.Conclusion Diabetes, hyperuricemia, left main lesions, C lesions, and implantation of too many internal stents are independent risk factors of MACCE after PCI in elderly patients with coronary heart disease.
- coronary heart disease /
- percutaneous coronary intervention /
- major adverse cardiovascular and cerebrovascular events /
- risk factors

HTML全文

表 1 PCI治疗前后患者血压及相关实验室指标

Table 1. Patient blood pressure and related laboratory indicators before and after PCI X±S

参数	术前	术后	t值	P值
平均动脉压/mmHg	86.83±14.61	88.65±14.36	1.640	0.102
白细胞/(×10⁹·L^-1)	6.63±1.98	7.15±2.36	2.261	0.024
红细胞/(×10¹²·L^-1)	4.36±0.89	4.03±0.60	0.942	0.347
血小板/(×10⁹·L^-1)	189.36±46.58	185.17±44.83	1.318	0.189
血红蛋白/(g·L^-1)	125.60±15.33	121.96±16.55	0.943	0.346
低密度脂蛋白胆固醇/(mmol·L^-1)	2.53±0.90	2.36±0.80	2.565	0.011
尿素氮/(mmol·L^-1)	7.58±4.30	8.15±5.87	0.891	0.374
肌酐/(μmol·L^-1)	93.66±27.80	91.85±26.55	0.658	0.511
尿酸/(μmol·L^-1)	0.38±0.11	0.37±0.10	0.142	0.886
谷丙转氨酶/(U·L^-1)	49.63±17.30	50.35±18.50	0.296	0.767
谷草转氨酶/(U·L^-1)	36.47±11.74	37.51±11.83	0.362	0.717

下载: 导出CSV

表 2 影响老年冠心病患者PCI术后MACCE发生的单因素分析

Table 2. Single factor analysis of MACCE in elderly patients with coronary heart disease after PCI 例(%), X±S

参数	MACCE组(96例)	无MACCE组(234例)	t/χ²值	P值
年龄/岁	73.50±7.25	72.88±6.63	0.751	0.453
男性	62(64.58)	143(61.11)	0.349	0.555
吸烟	49(51.04)	114(48.72)	0.147	0.701
糖尿病	46(47.92)	49(20.94)	24.165	< 0.001
肾功能不全	31(32.29)	35(14.96)	12.784	< 0.001
NYHA分级			6.580	0.010
<Ⅲ	63(65.63)	185(79.06)
≥Ⅲ	33(34.37)	49(20.94)
高尿酸	50(52.08)	75(32.05)	17.210	< 0.001
低密度脂蛋白胆固醇/(mmol·L^-1)	2.48±0.81	2.35±0.78	1.360	0.186
脑血管病史	13(13.54)	45(19.23)	1.521	0.217
周围血管病史	20(20.83)	33(14.10)	2.288	0.130
左主干病变	30(31.25)	16(6.84)	33.818	< 0.001
多支血管病变	60(62.50)	112(47.86)	5.844	0.016
C型病变	58(60.42)	73(31.20)	24.279	< 0.001
植入支架数量			10.357	0.001
<3枚	57(59.37)	180(76.92)
≥3枚	39(40.63)	54(23.08)
术后用药
阿司匹林	95(98.96)	234(100)	-	0.291
氯吡格雷	94(97.92)	234(100)	-	0.084
他汀药物	93(96.86)	228(97.44)	0.000	1.000
ACEI/ARB	86(89.58)	194(82.91)	2.361	0.124
β受体阻滞剂	85(88.54)	205(87.61)	0.056	0.813
注：“—”为Fisher精确概率法

下载: 导出CSV

表 3 非条件二分类Logistic回归分析中自变量赋值方法

Table 3. Evaluation method of independent variables in unconditional binary logistic regression analysis

自变量	赋值方法
糖尿病史	无=0，有=1
肾功能不全	无=0，有=1
高尿酸	无=0，有=1
NYHA分级	< Ⅲ级=0，≥Ⅲ级=1
多支血管病变	是=0，否=1
左主干病变	是=0，否=1
C型病变	是=0，否=1
植入支架数量	< 3枚=0，≥3枚=1

下载: 导出CSV

参考文献(20)

[1]	Krämer C, Meisinger C, Kirchberger I, et al. Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry[J]. Ann Med, 2021, 53(1): 2142-2152. doi: 10.1080/07853890.2021.2002926
[2]	Shiyovich A, Plakht Y, Gilutz H. Serum calcium levels independently predict in-hospital mortality in patients with acute myocardial infarction[J]. Nutr Metab Cardiovasc Dis, 2018, 28(5): 510-516. doi: 10.1016/j.numecd.2018.01.013
[3]	王娟, 张雨龙, 钟怡, 等. 经皮冠状动脉介入治疗伴发焦虑及抑郁情绪研究进展[J]. 中国全科医学, 2020, 23(23): 2938-2943. doi: 10.12114/j.issn.1007-9572.2019.00.668
[4]	Weferling M, Hamm CW, Kim WK. Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation Patients: Overview and Practical Management[J]. Front Cardiovasc Med, 2021, 8: 653768. doi: 10.3389/fcvm.2021.653768
[5]	郑士航, 高曼, 张飞飞, 等. GRACE评分联合中性粒细胞与淋巴细胞比值对急性STEMI患者PCI后无复流现象的预测价值[J]. 临床心血管病杂志, 2021, 37(9): 810-815. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202109007.htm
[6]	Sethi NJ, Safi S, Korang SK, et al. Antibiotics for secondary prevention of coronary heart disease[J]. Cochrane Database Syst Rev, 2021, 2: CD003610.
[7]	Hu MJ, Li XS, Jin C, et al. Does multivessel revascularization fit all patients with STEMI and multivessel coronary artery disease? A systematic review and meta-analysis[J]. Int J Cardiol Heart Vasc, 2021, 35: 100813.
[8]	Pullinger CR, O'Connor PM, Naya-Vigne JM, et al. Levels of Prebeta-1 High-Density Lipoprotein Are a Strong Independent Positive Risk Factor for Coronary Heart Disease and Myocardial Infarction: A Meta-Analysis[J]. J Am Heart Assoc, 2021, 10(7): e018381. doi: 10.1161/JAHA.120.018381
[9]	Razzouk L, Feit F, Farkouh ME. Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic Patients: Choosing Wisely Between PCI and Surgery[J]. Curr Cardiol Rep, 2017, 19(5): 37. doi: 10.1007/s11886-017-0849-7
[10]	Stolpe S, Kowall B, Stang A. Decline of coronary heart disease mortality is strongly effected by changing patterns of underlying causes of death: an analysis of mortality data from 27 countries of the WHO European region 2000 and 2013[J]. Eur J Epidemiol, 2021, 36(1): 57-68. doi: 10.1007/s10654-020-00699-0
[11]	余云华, 于亚梅, 李茂巍, 等. 高龄冠心病患者PCI术后主要心脑血管不良事件风险评估模型验证与分析研究[J]. 介入放射学杂志, 2018, 27(10): 953-958. doi: 10.3969/j.issn.1008-794X.2018.10.011
[12]	刘庆荣, 张海彤, 张洪亮, 等. 冠心病患者择期PCI术冠状动脉微循环损伤的危险因素研究[J]. 中国医刊, 2018, 53(12): 1330-1335. doi: 10.3969/j.issn.1008-1070.2018.12.008
[13]	刘睦胜, 晏景红, 王冬莉. 血清胆红素、糖化血红蛋白水平与老年冠心病合并2型糖尿病患者冠脉病变程度的相关性[J]. 中国老年学杂志, 2021, 41(9): 1808-1811. doi: 10.3969/j.issn.1005-9202.2021.09.006
[14]	Cui NH, Yang JM, Liu X, et al. Poly(ADP-Ribose)Polymerase Activity and Coronary Artery Disease in Type 2 Diabetes Mellitus: An Observational and Bidirectional Mendelian Randomization Study[J]. Arterioscler Thromb Vasc Biol, 2020, 40(10): 2516-2526. doi: 10.1161/ATVBAHA.120.314712
[15]	王燕宏, 刘平平, 王军. 2型糖尿病合并脑梗死患者颈动脉粥样硬化斑块发生的相关危险因素分析[J]. 中西医结合心脑血管病杂志, 2012, 10(4): 433-434. doi: 10.3969/j.issn.1672-1349.2012.04.027
[16]	Lim KK, Lee V, Tan CS, et al. Examining the heterogeneity inexcess risks of coronary heart disease, stroke, dialysis, and lower extremity amputation associated with type 2 diabetes mellitus across demographic subgroups in an Asian population: A population-based matched cohort study[J]. Diabetes Res Clin Pract, 2021, 171: 108551. doi: 10.1016/j.diabres.2020.108551
[17]	Cheong E, Ryu S, Lee JY, et al. Association between serum uric acid and cardiovascular mortality and all-cause mortality: a cohort study[J]. J Hypertens, 2017, 35 Suppl 1: S3-S9.
[18]	Konta T, Ichikawa K, Kawasaki R, et al. Association between serum uric acid levels and mortality: a nationwide community-based cohort study[J]. Sci Rep, 2020, 10(1): 6066. doi: 10.1038/s41598-020-63134-0
[19]	武金娥, 霍建华, 蒋永荣, 等. 老年冠心病患者PCI术后不良心脑血管事件的随访研究[J]. 西安交通大学学报(医学版), 2019, 40(4): 579-582. https://www.cnki.com.cn/Article/CJFDTOTAL-XAYX201904019.htm
[20]	Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent STsegment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent STsegment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2021, 42(14): 1289-1367.