青年急性冠状动脉综合征患者冠状动脉病变程度与预后的相关性研究
|
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.
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
[1] Andersson C,Vasan R S.Epidemiology of cardiovascular disease in young individuals.Nat Rev Cardiol,2018,15:230-240.
[2] Trzeciak P,Wozakowska-Kaplon B,Niedziela J,et al.Comparison of Inhospital and 12- and 36-Month Outcomes After Acute Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS Registry).Am J Cardiol,2016,118:1300-1305.
[3] Andersson C,Vasan R S.Epidemiology of cardiovascular disease in young individuals.Nat Rev Cardiol,2018,15:230-240.
[4] 中国高血压基层管理指南(2014年修订版).中华高血压杂志,2015:24-43.
[5] 中国2型糖尿病防治指南(2017年版).中国实用内科杂志,2018:292-344.
[6] 诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版).中国循环杂志,2016:937-953.
[7] Gensini G G.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606.
[8] Fox K A,Dabbous O H,Goldberg R J,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study (GRACE).BMJ,2006,333:1091.
[9] World Health Organization.World health statistics 2016.Monitoring health for the SDGs sustainable development goals.Geneva Switzerland WHO,2016,41:293-328.
[10] Global,regional,and national incidence,prevalence,and years lived with disability for 328 diseases and injuries for 195 countries,1990-2016:a systematic analysis for the global burden of disease study 2016.Lancet,2017,390:1211-1259.
[11] Feng J L,Nedkoff L,Knuiman M,et al.Temporal trends in sudden cardiac death from 1997 to 2010:a data linkage study.Heart Lung Circ,2017,26:808-816.
[12] Alkhawam H,Zaiem F,Sogomonian R,et al.Coronary artery disease in young adults.Am J Med Sci,2015,350:479-483.
[13] 王喜福,杨铎,曾玉杰.青年与老年急性心肌梗死患者血浆炎性因子的对比分析.心肺血管病杂志,2015,34:441-443.
[14] Jalowiec D A,Hill J A.Myocardial infarction in the young and in women.Cardiovasc Clin,1989,20:197-206.
[15] Shah N,Kelly A M,Cox N,et al.Myocardial infarction in the “young”:risk factors,presentation,management and prognosis.Heart Lung Circ,2016,25:955-960.
[16] Navas-Nacher E L,Colangelo L,Beam C,et al.Risk factors for coronary heart disease in men 18 to 39 years of age.Ann Intern Med,2001,134:433-439.
[17] Konishi H,Miyauchi K,Kasai T,et al.Long-term prognosis and clinical characteristics of young adults ≤40 years old) who underwent percutaneous coronary intervention.J Cardiol,2014,64:171-174.
[18] Cole J H,Miller J R,Sperling L S,et al.Long-term follow-up of coronary artery disease presenting in young adults.J Am Coll Cardiol,2003,41:521-528.
[19] Maroszynska-Dmoch E M,Wozakowska-Kaplon B.Clinical and angiographic characteristics of coronary artery disease in young adults:a single centre study.Kardiol Pol,2016,74:314-321.
[20] Fournier J A,Cabezon S,Cayuela A,et al.Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age.Am J Cardiol,2004,94:989-992.
[21] van Loon J E,de Maat M P,Deckers J W,et al.Prognostic markers in young patients with premature coronary heart disease.Atherosclerosis,2012,224:213-217.
[22] Fox K A,Dabbous O H,Goldberg R J,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study (GRACE).BMJ,2006,333:1091.
[23] Alnasser SM,Huang W,Gore JM,et al.Late Consequences of acute coronary syndromes:global registry of acute coronary events (grace) follow-up.Am J Med,2015,128:766-775.
[24] 付源,李奎宝,杨新春.红细胞分布宽度预测急性冠状动脉综合征合并慢性肾脏病患者院内病死率的价值.心肺血管病杂志,2018,37:33-38.
[25] 肖冰,罗太阳,刘新民,等.超质量和肥胖急性冠状动脉综合征患者超敏C-反应蛋白水平与冠状动脉Gensini积分的关系.心肺血管病杂志,2014,33:364-367.
[26] Sullivan DR,Marwick TH,Freedman SB.A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors.Am Heart J,1990,119:1262-1267.
[27] Samman TA,Sandesara P,Hayek SS,et al.High-sensitivity troponin i levels and coronary artery disease severity,progression,and long-term outcomes.J Am Heart Assoc,2018,7:e007914.
[28] Dai DF,Hwang JJ,Lin JL,et al.Joint effects of N-terminal pro-B-type-natriuretic peptide and C-reactive protein vs angiographic severity in predicting major adverse cardiovascular events and clinical restenosis after coronary angioplasty in patients with stable coronary artery disease.Circ J,2008,72:1316-1323.
[29] Qin W,Yang Y,Li X,et al.Value of mean platelet volume and Gensini score on predicting short-term outcome in acute ST segment elevation myocardial infarction patient post emergency percutaneous coronary intervention.Zhonghua Xin Xue Guan Bing Za Zhi,2015,43:22-25.
[30] Sinning C,Lillpopp L,Appelbaum S,et al.Angiographic score assessment improves cardiovascular risk prediction:the clinical value of SYNTAX and Gensini application.Clin Res Cardiol,2013,102:495-503.
[2] Trzeciak P,Wozakowska-Kaplon B,Niedziela J,et al.Comparison of Inhospital and 12- and 36-Month Outcomes After Acute Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS Registry).Am J Cardiol,2016,118:1300-1305.
[3] Andersson C,Vasan R S.Epidemiology of cardiovascular disease in young individuals.Nat Rev Cardiol,2018,15:230-240.
[4] 中国高血压基层管理指南(2014年修订版).中华高血压杂志,2015:24-43.
[5] 中国2型糖尿病防治指南(2017年版).中国实用内科杂志,2018:292-344.
[6] 诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版).中国循环杂志,2016:937-953.
[7] Gensini G G.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606.
[8] Fox K A,Dabbous O H,Goldberg R J,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study (GRACE).BMJ,2006,333:1091.
[9] World Health Organization.World health statistics 2016.Monitoring health for the SDGs sustainable development goals.Geneva Switzerland WHO,2016,41:293-328.
[10] Global,regional,and national incidence,prevalence,and years lived with disability for 328 diseases and injuries for 195 countries,1990-2016:a systematic analysis for the global burden of disease study 2016.Lancet,2017,390:1211-1259.
[11] Feng J L,Nedkoff L,Knuiman M,et al.Temporal trends in sudden cardiac death from 1997 to 2010:a data linkage study.Heart Lung Circ,2017,26:808-816.
[12] Alkhawam H,Zaiem F,Sogomonian R,et al.Coronary artery disease in young adults.Am J Med Sci,2015,350:479-483.
[13] 王喜福,杨铎,曾玉杰.青年与老年急性心肌梗死患者血浆炎性因子的对比分析.心肺血管病杂志,2015,34:441-443.
[14] Jalowiec D A,Hill J A.Myocardial infarction in the young and in women.Cardiovasc Clin,1989,20:197-206.
[15] Shah N,Kelly A M,Cox N,et al.Myocardial infarction in the “young”:risk factors,presentation,management and prognosis.Heart Lung Circ,2016,25:955-960.
[16] Navas-Nacher E L,Colangelo L,Beam C,et al.Risk factors for coronary heart disease in men 18 to 39 years of age.Ann Intern Med,2001,134:433-439.
[17] Konishi H,Miyauchi K,Kasai T,et al.Long-term prognosis and clinical characteristics of young adults ≤40 years old) who underwent percutaneous coronary intervention.J Cardiol,2014,64:171-174.
[18] Cole J H,Miller J R,Sperling L S,et al.Long-term follow-up of coronary artery disease presenting in young adults.J Am Coll Cardiol,2003,41:521-528.
[19] Maroszynska-Dmoch E M,Wozakowska-Kaplon B.Clinical and angiographic characteristics of coronary artery disease in young adults:a single centre study.Kardiol Pol,2016,74:314-321.
[20] Fournier J A,Cabezon S,Cayuela A,et al.Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age.Am J Cardiol,2004,94:989-992.
[21] van Loon J E,de Maat M P,Deckers J W,et al.Prognostic markers in young patients with premature coronary heart disease.Atherosclerosis,2012,224:213-217.
[22] Fox K A,Dabbous O H,Goldberg R J,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study (GRACE).BMJ,2006,333:1091.
[23] Alnasser SM,Huang W,Gore JM,et al.Late Consequences of acute coronary syndromes:global registry of acute coronary events (grace) follow-up.Am J Med,2015,128:766-775.
[24] 付源,李奎宝,杨新春.红细胞分布宽度预测急性冠状动脉综合征合并慢性肾脏病患者院内病死率的价值.心肺血管病杂志,2018,37:33-38.
[25] 肖冰,罗太阳,刘新民,等.超质量和肥胖急性冠状动脉综合征患者超敏C-反应蛋白水平与冠状动脉Gensini积分的关系.心肺血管病杂志,2014,33:364-367.
[26] Sullivan DR,Marwick TH,Freedman SB.A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors.Am Heart J,1990,119:1262-1267.
[27] Samman TA,Sandesara P,Hayek SS,et al.High-sensitivity troponin i levels and coronary artery disease severity,progression,and long-term outcomes.J Am Heart Assoc,2018,7:e007914.
[28] Dai DF,Hwang JJ,Lin JL,et al.Joint effects of N-terminal pro-B-type-natriuretic peptide and C-reactive protein vs angiographic severity in predicting major adverse cardiovascular events and clinical restenosis after coronary angioplasty in patients with stable coronary artery disease.Circ J,2008,72:1316-1323.
[29] Qin W,Yang Y,Li X,et al.Value of mean platelet volume and Gensini score on predicting short-term outcome in acute ST segment elevation myocardial infarction patient post emergency percutaneous coronary intervention.Zhonghua Xin Xue Guan Bing Za Zhi,2015,43:22-25.
[30] Sinning C,Lillpopp L,Appelbaum S,et al.Angiographic score assessment improves cardiovascular risk prediction:the clinical value of SYNTAX and Gensini application.Clin Res Cardiol,2013,102:495-503.