SYNTAX积分及EURO积分双高冠心病高危患者PCI与药物治疗对照研究

发布时间：2018-03-15 11:37

  本文选题：SYNTAX积分　切入点：EURO积分　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:SYNTAX积分27及Euro积分6分双高冠心病高危患者,通过比较经皮冠状动脉介入治疗(Percutaneous Coronary Intervention PCI)或药物治疗后不良心血管事件发生率,指导心内科临床医生,制订适宜我国Syntax积分及Euro积分双高冠心病高危患者的个体化治疗策略。方法:回顾性分析研究2014年1月至2015年6月中国人民解放军白求恩国际和平医院心内科冠脉造影证实为左主干病变和(或)三支病变,SYNTAX积分27分及Euro积分6分(简称:SE双高积分)的冠心病高危患者101例。根据患者选择治疗方法的不同,分为单纯口服药物治疗组(简称:药物治疗组)和PCI组。通过查阅住院病历,门诊或电话随访,记录患者出院后发生不良心血管事件的时间和类型。观察指标:1.主要不良心血管终点事件:全因死亡、非致死性心肌梗死、靶血管重建。2.次要不良心血管终点事件:心功能减退、心源性再入院、再发心绞痛。分别计算PCI治疗组和药物治疗组主要不良心血管事件发生率和次要不良心血管事件发生率,通过卡方检验来判别两组之间的不良心血管事件发生率是否有区别,并对不良心血管事件做Kaplan-Meier分析,绘制无不良心血管事件生存曲线,对生存曲线进行Log Rank(Mantel-Cox)检验,并对相关危险因素进行Cox比例风险回归分析。结果:1随访到18个月时,药物治疗组发生主要不良心血管事件(Major Adverse Cardiovascular Events MACE)17例(占药物治疗组34.00%),PCI组发生MACE 6例(占PCI组11.76%),两组MACE发生率差异有统计学意义,P=0.008,PCI组MACE发生率低于药物治疗组。药物治疗组发生心功能减退21例(占药物治疗组42.00%),PCI组发生心功能减退10例(占PCI组19.61%),两组心功能减退发生率有统计学意义,P=0.015,PCI组心功能减退发生率低于药物治疗组;药物治疗组发生心源性再入院25例(占药物治疗组50.00%),PCI组发生心源性再入院11例(占PCI组21.57%),两组心源性再入院发生率有统计学意义,P=0.003,PCI组心源性再入院发生率低于药物治疗组;药物治疗组发生再发心绞痛21例(占药物治疗组42.00%),PCI组发生再发心绞痛9例(占PCI组17.64%),两组再发心绞痛发生率有统计学意义,P=0.007,PCI组再发心绞痛发生率低于药物治疗组。2 Kaplan-Meier结果示:药物治疗组无不良心血管事件生存时间平均值9.660±0.868月,95%置信区间(7.959-11.361月),PCI组无不良心血管事件生存时间平均值12.725±0.870月,95%置信区间(11.021-14.430月)。3对药物治疗组和PCI组生存曲线做Log Rank(Mantel-Cox)检验,P=0.001,差异有统计学意义。4采用逐步回归法对相关危险因素:治疗方法、性别、吸烟史、慢性肺部疾病、糖尿病、高血压、高血脂、SYNTAX积分、Euro积分进行Cox比例风险回归分析,Cox模型似然比检验P=0.001,配合模型时,进入模型和从模型中剔除的水准分别为0.05和0.10,筛选后的最佳模型包含1个协变量:治疗方法,P=0.001,其对应的回归系数为0.882,相对危险度为2.416,说明SYNTAX积分及Euro积分双高冠心病高危患者选择药物治疗发生不良心血管事件的风险是选择介入治疗的2.416倍。结论:1 SYNTAX积分及Euro积分双高冠心病高危患者在采用PCI治疗后,与药物治疗组比,长期随访(≥6个月)发现主要和次要不良心血管事件发生率都有明显降低。2 SYNTAX积分及Euro积分双高冠心病高危患者PCI治疗组患者无不良心血管事件的平均生存时间和中位生存时间长于药物治疗组患者。3 SYNTAX积分及Euro积分双高冠心病高危患者选择药物治疗发生不良心血管事件的风险是选择介入治疗的2.416倍。
[Abstract]:Objective: SYNTAX 27 and Euro integral 6 points high high risk of coronary heart disease patients, through the comparison of percutaneous coronary intervention (Percutaneous Coronary Intervention PCI) or the incidence of adverse cardiovascular events after drug treatment, guide the Department of Cardiology clinicians to formulate appropriate individualized treatment strategies in China Syntax integral and Euro integral double high risk of coronary heart disease patients. Methods: a retrospective study from January 2014 to June 2015 Chinese people's Liberation Army Bethune Department of Cardiology Heping Hospital confirmed by coronary angiography of left main disease and (or) three lesions, SYNTAX score of 27 points and 6 points Euro (abbreviation: SE double integral) in 101 cases of coronary heart disease in high-risk patients. According to the different treatment methods were divided into simple. Oral drug treatment group (referred to as: drug treatment group) and PCI group. The patients' medical records, telephone or outpatient follow-up records of patients discharged from hospital The time and type after the occurrence of adverse cardiovascular events. Observation index: 1. major adverse cardiovascular events: the end point of all-cause death, nonfatal myocardial infarction, target vessel revascularization.2. minor adverse cardiovascular end point events: heart failure cardiac readmission, recurrent angina. PCI treatment group and drug treatment group of major adverse cardiovascular the incidence rate of adverse cardiovascular events and minor incidence were calculated to determine the adverse cardiovascular events between the two groups in the incidence of whether there are differences by chi square test, and the adverse cardiovascular events do Kaplan-Meier analysis, no adverse cardiovascular events draw survival curves, Log Rank survival curve (Mantel-Cox) test, and the related regression analysis of risk factors Cox regression. Results: followed up for 1 to 18 months, the drug treatment group had major adverse cardiovascular events (Major Adverse Cardiovascular Events (MACE) 17 cases accounted for 34% in the medical treatment group), group PCI and MACE occurred in 6 patients (PCI group 11.76%), two groups of MACE were statistically significant differences in P=0.008, PCI rate, MACE incidence rate was lower than the drug treatment group. Drug treatment group had heart dysfunction in 21 cases (treatment group accounted for 42%) PCI group, the occurrence of heart dysfunction in 10 cases (PCI group 19.61%), two groups of heart failure incidence was statistically significant, P=0.015, PCI group of heart dysfunction rate is lower than the drug treatment group; drug treatment group had 25 cases of cardiac readmission (accounted for 50% in the medical treatment group), group PCI had cardiogenic readmission in 11 cases (PCI group 21.57%), two groups of cardiac readmission was statistically significant, the incidence rate of P=0.003, PCI group cardiac readmission rate is lower than the drug treatment group; drug treatment group had recurrent angina (21 cases accounted for 42% in the medical treatment group), PCI group had recurrent angina pectoris 9 cases (accounting for PCI 缁，

本文编号：1615867