无左主干三支血管病变冠心病患者三种治疗预后比较及危险因素分析

发布时间：2018-03-17 08:28

  本文选题：冠心病　切入点：三支病变　出处：《济南大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究冠心病患者开展冠状动脉造影(CAG)检查显示冠状动脉(冠脉)的三支血管出现病变(TVD)(无左主干病变),接受以下三种不同治疗方案即经皮冠状动脉介入治疗(PCI,PCI组)、单纯的药物治疗组(药物组)及冠状动脉旁路移植术(CABG,CABG组)的预后,以及预后与危险因素之间的关系。方法:回顾性连续性收集560例于2012年1月到2016年1月间入济南市第四人民医院开展CAG检查示为无左主干的TVD冠心病患者,进行随访的年限大约为1~4年,共510例患者进行了有效的随访,随访的成功率在98.0%。病例按治疗方案不同分为药物组(n=116),PCI组(n=274),及CABG组(n=120),又根据是否完全性血运重建将PCI组患者又分成完全组及不完全组。主要随访发生的不良的心脑血管事件(MACCE),其包括:再次冠脉血运重建、心源性死亡、脑卒中及再发性心肌梗死。开展三种治疗方案的预后比较,然后再将不同组患者的MACCE发生率与临床的资料进行回归性分析,从而得出MACCE率的独立性的危险因素。结果:1.不同治疗方案组的预后的比较,药物组的MACCE率、再发性心肌梗死率、心源性死亡率均高于CABG组及PCI组(P0.05),而脑卒中率与CABG组无差异(P0.05),而高于PCI组(P0.05)。PCI组在再次冠脉血运重建率、MACCE率、再发性心肌梗死率以及心源性死亡率方面高于CABG组(P0.05),脑卒中率CABG高于PCI组(P0.05)。然后再根据SYNTAX积分低(0-22分)、中(23-32分)及高(≥33分)三组分别比较三组的MACCE率。低SYNTAX积分组PCI组、药物组及CABG组在心源性死亡率、MACCE率、再发性的心肌梗死率,以及CABG组和PCI组在再次冠脉血运重建率,上述均无统计学差异(P0.05),而在脑卒中率CABG组高于PCI组与药物组(P0.05)。中SYNTAX积分组药物组在再发性心肌梗死率、心源性死亡率、MACCE及脑卒中率均高于CABG组及PCI组(P0.05)。而PCI组在心源性死亡率、MACCE率、再次冠脉血运重建率及再发性心肌梗死率比较高于CABG组,均有统计学意(P0.05)。高SYNTAX积分方面在MACCE率、心源性死亡率及再发性心肌梗死率方面,而CABG最低,PCI组居中,药物组最高,均有统计学意义(P0.05),而CABG组在再次冠脉血运重建低于PCI组,有统计学差异(P0.05)。药物组在脑卒中与CABG组及PCI组的比较三组间均无明显差异(P0.05)。回归性分析显示药物组最低,PCI组次之及CABG组生存率最高。2.PCI治疗不完全组在再次冠脉血运重建率、MACCE率、再发性心肌梗死率及心源性死亡率高于完全组,上述有统计学差异(P0.05),而脑卒中率无统计学差异(P0.05)。回归性分析显示PCI治疗完全组生存率高于不完全性组。3.高脂血症史、身高体重指数(BMI)、年龄、急性心肌梗死、贫困、糖尿病病史、高血压病史、吸烟史、心血管病史、血甘油三酯(TG)、血胆固醇(TC)、左室的射血分数(LVEF)、低密度脂蛋白(LDL-C)、冠状动脉慢性闭塞性(CTO)病变及SYNTAX是MACCE发生率的独立性的危险因素,其中糖尿病病史及高血压病史影响较为明显。结论:1.无左主干TVD冠心病患者在总的预后比较药物治疗效果差,CABG治疗效果较好,PCI治疗居中。而在SYNTAX低积分组,PCI治疗、药物组及CABG治疗的预后无明显差异,而在SYNTAX中、高积分组,药物组预后差,CABG组预后最好及PCI组预后居中。据生存分析示不同治疗方案为MACCE率的独立性危险因素。2.PCI组中不完全组的CTO病变、急性心肌梗死及高SYNTAX积分的比例叫高于完全组。完全组的MACCE发生率低及生存率高,据生存分析示血运重建不完全为MACCE率的独立性危险因素。3.急性心肌梗死、高脂血症史、BMI、年龄、贫困、吸烟史、糖尿病病史、高血压病史、心血管病史、CTO病变、LVEF、SYNTAX、TG、TC及LDL-C为MACCE率的独立性的危险因素,其中糖尿病及高血压病史影响较为明显。
[Abstract]:Objective: To study the development of coronary angiography in patients with coronary heart disease (CAG) coronary angiography (CAG) showed three vessel lesions (TVD) (left main lesion), accept the following three different treatment regimens with percutaneous coronary intervention (PCI, group PCI), single drug treatment group (drug group) and coronary artery bypass grafting (CABG group CABG) prognosis, and the relationship between the prognosis and risk factors. Methods: We retrospectively collected 560 cases of continuity from January 2012 to January 2016 in the Fourth People's Hospital of Ji'nan city to carry out CAG examination showed no TVD left main coronary heart disease patients, follow-up period about 1~4 years, a total of 510 patients were effective follow-up, follow-up success rate in 98.0%. patients according to the different treatment were divided into drug group (n=116), PCI group (n=274), and CABG group (n=120), according to whether the complete revascularization group PCI patients Divided into group and incomplete follow-up group. Main adverse cardiovascular events (MACCE), including: revascularization, cardiac death, stroke and recurrent myocardial infarction. The prognosis of three to carry out treatment, then compare the different groups of patients with MACCE incidence and clinical the data regression analysis, thus obtains the independent risk factor of MACCE rate. Results: compared with the prognosis of 1. different treatment group, drug group MACCE rate, recurrent myocardial infarction, cardiac mortality was higher than that of CABG group and PCI group (P0.05), and stroke rate and CABG group no difference (P0.05), and higher than that of group PCI (P0.05).PCI group in the revascularization rate, MACCE rate, recurrent myocardial infarction and cardiogenic mortality rate is higher than that of CABG group (P0.05), stroke rate of CABG is higher than that of PCI group (P0.05). Then according to the SYNTAX score low (0-22 鍒，

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