摘要
目的:在青年急性冠状动脉综合征(ACS)患者中评估与冠状动脉病变严重程度相关的危险因素,并探讨其预后意义。方法:连续收录2016年1月至2017年10月,在北京安贞医院行经皮冠状动脉介入(PCI)治疗的1 148例,年龄≤40岁的青年ACS患者,以Gensini积分方法评价冠状动脉病变的严重程度,通过对不同冠状动脉病变严重程度患者基线特征的比较,分析与冠状动脉病变程度相关的临床因素;对所有患者进行为期一年的术后随访,以出现全因死亡、再发心肌梗死、严重心力衰竭入院以及3个月以上非计划再次血运重建的不良事件(MACE)作为终点事件。结果:对不同病变程度的患者组间比较,糖尿病、高血压、BMI、TC、HDL-C、LDL-C、TG、HCY的差异有统计学意义(P<0.05),Gensini积分与糖尿病病史、血糖、TC、TG、LDL-C呈正相关,差异有统计学意义(P<0.05),Gensini积分是青年ACS患者PCI术后12个月预后的危险因素,HR(95%CI)为1.433(1.065~1.927,P=0.017),对GRACE预测价值的C-index提升△C为0.150(95%CI:0.044~0.255,P=0.003),显著改善了模型的C统计量。结论:青年ACS患者冠状动脉病变严重程度与传统心血管危险因素相关,Gensini积分对青年ACS患者PCI术后12个月预后有预测价值。
Objective: To evaluate the risk factors associated with the severity of coronary lesions in young patients with acute coronary syndrome(ACS) and explore the prognostic significance. Methods: Young patients with ACS suffered coronary intervention(PCI) therapy(n=1148), aged 18 to 40 years old, were continuous recorded in Beijing Anzhen hospital between January 2016 and October 2017. The severity of coronary lesions of patients was evaluated by the number of vascular lesions and Gensini score. By comparing the baseline characteristics of patients with different severity of coronary artery disease, the clinical factors related to the severity of coronary lesions were analyzed. All patients were followed up for one year, the end-point events were defined as the major cardiovascular events(MACE) including all-cause death, recurrent myocardial infarction, admission to hospital with severe heart failure and unplanned revascularization for more than 3 months. Risk factors were identified by a Cox model, the relationship between Gensini score and prognosis were analyzed, and the improvement of GRACE score prediction ability was explored as well. Results: Comparison between groups of patients with different degrees of lesion showed that, diabetes, high blood pressure and BMI were statistically significant(P<0.05), the Gensini score and history of diabetes, blood glucose, total cholesterol, TG, LDL-C were positively correlated, the difference was statistically significant(P<0.05). The Gensini score was the independent risk factor of prognosis for young patients with ACS after PCI, HR was 1.433(95%CI: 1.065-1.927,P=0.017). The C-index elevation of GRACE′s predicted value was 0.150(95% CI: 0.044-0.255, P=0.003), which significantly improved the C statistics of the model. Conclusions: The severity of coronary lesions in young patients with ACS is associated with traditional cardiovascular risk factors, and the Gensini score has predictive value for 1-year prognosis after PCI in young ACS patients.
引文
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