冠心病三支病变不良预后患者临床特点与治疗策略分析

发布时间：2018-04-17 20:07

  本文选题：冠心病 + 三支病变　； 参考：《华中科技大学学报(医学版)》2017年06期

【摘要】：目的探讨冠心病三支病变(three-vessel disease,TVD)预后不良患者的临床特点,以及经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)和单纯药物治疗等3种治疗方式对远期预后的影响,以期为临床治疗策略提供参考。方法连续入组2004年4月至2011年2月在阜外医院入院的TVD患者8 943例。对所收集的TVD患者大样本随访得到的1年主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular events,MACCE)组和非MACCE组进行临床因素和治疗策略对比分析。结果与非MACCE组相比,MACCE组年龄更大、心肾功能更差、合并症包括糖尿病、卒中等更多,冠脉病变更复杂。校正多因素后,血肌酐水平、出院带药阿司匹林独立影响MACCE。MACCE组和非MACCE组患者治疗策略存在明显差异(P0.01)。MACCE组血运重建显著少于非MACCE组(64.9%vs.76.2%,P0.01),其中PCI组间无差异(46.1%vs.46.2%,P=0.533);差异来自MACCE组CABG显著少于非MACCE组(18.8%vs.30.0%,P0.01),而单纯药物治疗显著多于非MACCE组(35.1%vs.23.8%,P0.01)。结论肾功能和服用阿司匹林是TVD患者心脑血管不良事件的独立影响因素。非MACCE组患者血运重建要显著多于MACCE组患者。血运重建可能是改善TVD患者预后的重要因素。
[Abstract]:Objective to investigate the clinical characteristics of patients with poor prognosis of three-vessel disease with coronary artery disease (three-vessel disease), and the effects of three methods of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABGG) and drug therapy on the long-term prognosis.In order to provide reference for clinical treatment strategy.Methods from April 2004 to February 2011, 8 943 TVD patients were admitted to Fuwei Hospital.The clinical factors and treatment strategies of major adverse cardiovascular and cerebrovascular events (Macce) group and non- group were compared and analyzed in a large sample of TVD patients who were followed up for one year.Results compared with the control group, MACCE group was older and worse in heart and kidney function. The complications included diabetes mellitus, more stroke and more complicated coronary artery disease.After adjusting for multiple factors, serum creatinine levels,There were significant differences in treatment strategies between the MACCE.MACCE group and the non MACCE group. There was a significant difference between the two groups. There was a significant difference in blood revascularization between the two groups (P0.01n. MACCE group was significantly lower than that in the non- group (64.9vs.76.2cm). There was no significant difference between the PCI group (46.1vs.46.2vs.46.2p0.533); the difference was between the MACCE group and the non- group (18.8vs.30.0P0.01g), and the difference was significantly lower than that in the non- group (18.8vs.30.01g).The pure drug therapy was significantly more than that in the non-MACCE group (35. 1% vs 23. 8% P 0. 01).Conclusion Renal function and aspirin are independent factors of cardiovascular and cerebrovascular adverse events in TVD patients.Revascularization in non-MACCE group was significantly more than that in MACCE group.Revascularization may be an important factor in improving the prognosis of TVD patients.
【作者单位】： 中国医学科学院北京协和医学院阜外医院国家心脏病中心;
【基金】：国家重点基础研究发展计划资助项目(No.2010CB732601) 国家高技术研究发展计划资助项目(No.2015AA020407) 国家自然科学基金资助项目(No.81470380) 国家科技支撑计划资助项目(No.2016YFC1301301) 中国医学科学院医学与健康科技创新工程资助项目(No.2016-I2M-1-002)
【分类号】：R541.4
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