动脉穿刺路径在冠状动脉介入治疗中的应用现状及对预后的影响:单中心10557例患者经验

发布时间：2019-03-30 16:25

【摘要】：目的:通过对单中心大样本经皮冠状动脉(冠脉)介入治疗(PCI)患者2年随访结果的分析,探讨经股动脉路径患者的临床特点,比较股动脉路径、桡动脉路径的安全性和对预后的影响。方法:在2013年阜外医院10 557例经股动脉路径和桡动脉路径穿刺的PCI患者中,比较桡动脉路径组(n=9 745)和股动脉路径组(n=812)患者的临床特点,分析不同动脉路径对预后的影响。结果:经桡动脉路径患者9 745例(90.9%);经股动脉路径患者812例(7.6%),股动脉路径组患者中,高龄、女性、糖尿病、陈旧性心肌梗死、PCI史、冠脉旁路移植术(CABG)史患者比例更高,差异均有统计学意义(P0.001);股动脉路径组患者冠脉左主干病变、左主干或三支病变更多见,差异均有统计学意义(P0.001)。Logistic回归分析:女性、年龄、陈旧性心肌梗死、PCI史、CABG史,左主干病变均是选择股动脉路径的预测因素。倾向性评分匹配后,股动脉路径组住院期间死亡率较桡动脉路径组高,差异均有统计学意义(P0.05)。2年随访Kaplan-Meier生存分析所有终点事件均没有显著性差异。Cox多因素回归分析发现,股动脉路径是出血学术研究联合会(BARC)分级2型以上出血的独立危险因素(HR=2.210,P=0.013),不是主要心脏终点事件的独立危险因素。结论:(1)女性,高龄,陈旧性心肌梗死,PCI史,CABG史,左主干病变均是股动脉路径的预测因素;(2)经股动脉路径患者住院期间死亡率较桡动脉路径患者高;(3)股动脉路径是BARC分级2型以上出血的独立危险因素,但对PCI治疗患者的长期预后无明显影响。
[Abstract]:Objective: to investigate the clinical characteristics of patients undergoing percutaneous coronary intervention (PCI) by single center and large sample percutaneous coronary intervention (PCI) for 2 years, and to compare the femoral artery pathway. Safety of radial artery pathway and its prognostic implications. Methods: the clinical characteristics of 10 557 patients with PCI through femoral artery pathway and radial artery pathway in Fuwai Hospital in 2013 were compared with those of radial artery pathway group (n = 9,745) and femoral artery pathway group (n = 812). The effects of different arterial pathways on prognosis were analyzed. Results: 9 745 cases (90.9%) were treated by radial artery route. The proportion of elderly, female, diabetic, old myocardial infarction, PCI history and (CABG) history of coronary artery bypass grafting was higher in the femoral artery pathway group than in the femoral artery pathway group (7.6%), and in the femoral artery pathway group, the proportion of elderly, female, diabetic, old myocardial infarction, coronary artery bypass grafting history was higher. The difference was statistically significant (P0.001). The left main coronary artery lesions, left main coronary artery lesions or three vessel lesions were more common in the femoral artery pathway group (P0.001). Logistic regression analysis showed that female, age, old myocardial infarction, PCI history, CABG history, and left main coronary artery lesion were more common in the femoral artery pathway group than those in the left main coronary artery group (P0.001). Left main artery lesions are predictors of the choice of femoral artery pathways. The mortality rate in the femoral artery pathway group was higher than that in the radial artery pathway group after matching the tendency score. The difference was statistically significant (P0.05). There was no significant difference in all end-point events after 2-year follow-up Kaplan-Meier survival analysis. Cox multivariate regression analysis showed that there was no significant difference between the two groups. Femoral artery pathway is an independent risk factor (HR=2.210,P=0.013) for (BARC) grade 2 or more bleeding, not an independent risk factor for major cardiac endpoint events. Conclusion: (1) female, old age, old myocardial infarction, PCI history, CABG history, left main artery disease are all predictors of femoral artery pathway, (2) the mortality of patients with femoral artery pathway during hospitalization is higher than that of radial artery pathway. (3) femoral artery pathway is an independent risk factor for BARC grade 2 or more bleeding, but it has no significant effect on the long-term prognosis of PCI patients.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科;
【基金】：“十二五”国家科技支撑计划项目(2011BAI11B07) 国家自然科学基金(81470486)
【分类号】：R541.4

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