冠状动脉造影检查疑似冠心病患者6040例合并传统心血管病危险因素的临床分析
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摘要
目的对临床上冠心病患者合并传统心血管病危险因素进行分析。方法纳入本中心2013年1月至2015年2月因冠心病或疑似冠心病行冠状动脉造影(CAG)检查的住院患者,将存在严重冠心病并接受经皮冠状动脉介入治疗(PCI)的患者归为PCI组(2808例),不存在严重冠心病且未行PCI/冠状动脉旁路移植术(CABG)的患者归为No-PCI/CABG组(3232例)。PCI组再分为急性ST段抬高心肌梗死(STEMI)组、非ST段抬高急性心肌梗死/不稳定型心绞痛(NSTEMI/UA)组和稳定型心绞痛(SA)组。对临床上合并的传统心血管病危险因素进行回顾性分析。结果 (1)PCI组患者男性比例(75.4%比53.1%,P<0.0001)、平均年龄[(64.83±0.20)岁比(63.39±0.18)岁,P<0.0001]、高血压病(66.7%比54.7%,P<0.0001)、糖尿病/糖耐量异常(37.0%比20.8%,P<0.0001)、卒中(7.0%比5.4%,P=0.0098)和慢性肾病(4.3%比2.8%,P=0.001)比例显著高于NoPCI/CABG组;而两组间高脂血症的比例,差异无统计学意义(P>0.05)。(2)PCI组中女性高血压病(74.1%比64.3%,P<0.0001)、糖尿病/糖耐量异常(42.5%比35.3%,P=0.0007)和卒中(9.4%比6.2%,P=0.0054)比例均显著高于男性,差异均有统计学意义;无论PCI组还是No-PCI/CABG组,女性高脂血症比例均显著高于男性。(3)对PCI组进行亚组分析发现,STEMI组男性比例显著高于NSTEMI/UA组和SA组(83.9%比72.9%比72.3%,P<0.0001),而发病年龄显著小于NSTEMI/UA组和SA组[(62.54±0.45)岁比(65.15±0.28)岁比(66.17±0.34)岁,P<0.0001]。SA组高血压病(71.9%比66.9%比60.0%,P<0.0001)和既往靶血管血运重建(PCI/CABG)(33.9%比18.7%比7.2%,P<0.0001)比例显著高于STEMI组和NSTEMI/UA组;NSTEMI/UA组糖尿病/糖耐量异常比例显著高于STEMI组和SA组(39.7%比35.1%比34.4%,P<0.0001),差异均有统计学意义;而高脂血症、慢性肾病和卒中的比例三亚组间差异无统计学意义(P>0.05)。结论高血压病和糖尿病是冠心病最重要的危险因素,既往靶血管血运重建是SA和NSTEMI/UA患者靶血管再次血运重建的重要原因;行PCI的严重冠心病患者中,男性比例高于女性,但女性合并高血压病、糖尿病/糖耐量异常和卒中的比例高于男性。
Objective To analyze the real world status of traditional known cardiovascular risk factors in patients with coronary heart disease( CHD). Methods 6040 in-hospital patients with CHD or suspected CHD undergoing angiography from 01 /01 /2013 to 02 /28 /2015 were retrospectively analyzed.According to angiography result,patients with severe coronary artery lesion and undergoing percutaneous coronary intervention( PCI) were enrolled in the PCI group( n = 2808) and patients without severe coronary artery lesion and not undergoing PCI or CABG were enrolled in the No-PCI / CABG group( n = 3232). Patients in the PCI group were further divided into 3 subgroups which were STEMI group,NSTEMI / UA group and stable angina( SA) group. Results( 1) Compared with the No-PCI / CABG group,patients in the PCI group have higher ratio of male patients( 75. 4% vs. 53. 1%,P < 0. 0001),older average age( 64. 83 ± 0. 20 vs.63. 39 ± 0. 18 years old, P < 0. 0001), and higher existing rates of traditional risk factors including hypertension( 66. 7% vs. 54. 7%,P < 0. 0001),diabetes / impaired glucose tolerance( IGT)( 37. 0% vs.20. 8%,P < 0. 0001),stroke( 7. 0% vs. 5. 4%,P = 0. 0098) and chronic kidney disease( CKD)( 4. 3% vs.2. 8%,P = 0. 001),but there was no statistic difference in existing rates of dyslipidemia between the two groups.( 2) In the PCI group,female patients had higher prevalence of hypertension( 74. 1% vs. 64. 3%,P <0. 001),diabetes / IGT( 42. 5% vs. 35. 3%,P = 0. 0007) and stroke( 9. 4% vs. 6. 2%,P = 0. 0054) than the male patients. There were no significant sex difference in these comorbidities as above in No-PCI / CABG group. Female patients had higher prevalence of dyslipidemia than male patients in both PCI and No-PCI /CABG groups.( 3) Among all the 3 PCI subgroups,STEMI patients presented with youngest average age( 62. 54 ±0. 45 vs. 65. 15 ± 0. 28 vs. 66. 17 ± 0. 34 years old,P < 0. 0001) and highest male patient ratio( 83. 9% vs. 72. 9% vs. 72. 3%,P < 0. 0001). Patients in the SA subgroup had the highest prevalence of hypertension and prior revascularization including PCI and CABG. Patients in the NSTEMI / UA subgroup had the highest rates of diabetes / IGT. No significant differences were observed in the prevalence of dyslipidemia,CKD and stroke among all the subgroups. Conclusions Hypertension and diabetes are the leading risk factors of coronary artery disease,and prior revascularization is also an important cause of stable angina and NSTEMI /UA undergoing PCI. Patients requiring PCI were found to be more of male gendor,but female patients has higher prevalence of traditional cardiovascular risk factors including hypertension,diabetes / IGT or stroke than male patients.
Objective To analyze the real world status of traditional known cardiovascular risk factors in patients with coronary heart disease( CHD). Methods 6040 in-hospital patients with CHD or suspected CHD undergoing angiography from 01 /01 /2013 to 02 /28 /2015 were retrospectively analyzed.According to angiography result,patients with severe coronary artery lesion and undergoing percutaneous coronary intervention( PCI) were enrolled in the PCI group( n = 2808) and patients without severe coronary artery lesion and not undergoing PCI or CABG were enrolled in the No-PCI / CABG group( n = 3232). Patients in the PCI group were further divided into 3 subgroups which were STEMI group,NSTEMI / UA group and stable angina( SA) group. Results( 1) Compared with the No-PCI / CABG group,patients in the PCI group have higher ratio of male patients( 75. 4% vs. 53. 1%,P < 0. 0001),older average age( 64. 83 ± 0. 20 vs.63. 39 ± 0. 18 years old, P < 0. 0001), and higher existing rates of traditional risk factors including hypertension( 66. 7% vs. 54. 7%,P < 0. 0001),diabetes / impaired glucose tolerance( IGT)( 37. 0% vs.20. 8%,P < 0. 0001),stroke( 7. 0% vs. 5. 4%,P = 0. 0098) and chronic kidney disease( CKD)( 4. 3% vs.2. 8%,P = 0. 001),but there was no statistic difference in existing rates of dyslipidemia between the two groups.( 2) In the PCI group,female patients had higher prevalence of hypertension( 74. 1% vs. 64. 3%,P <0. 001),diabetes / IGT( 42. 5% vs. 35. 3%,P = 0. 0007) and stroke( 9. 4% vs. 6. 2%,P = 0. 0054) than the male patients. There were no significant sex difference in these comorbidities as above in No-PCI / CABG group. Female patients had higher prevalence of dyslipidemia than male patients in both PCI and No-PCI /CABG groups.( 3) Among all the 3 PCI subgroups,STEMI patients presented with youngest average age( 62. 54 ±0. 45 vs. 65. 15 ± 0. 28 vs. 66. 17 ± 0. 34 years old,P < 0. 0001) and highest male patient ratio( 83. 9% vs. 72. 9% vs. 72. 3%,P < 0. 0001). Patients in the SA subgroup had the highest prevalence of hypertension and prior revascularization including PCI and CABG. Patients in the NSTEMI / UA subgroup had the highest rates of diabetes / IGT. No significant differences were observed in the prevalence of dyslipidemia,CKD and stroke among all the subgroups. Conclusions Hypertension and diabetes are the leading risk factors of coronary artery disease,and prior revascularization is also an important cause of stable angina and NSTEMI /UA undergoing PCI. Patients requiring PCI were found to be more of male gendor,but female patients has higher prevalence of traditional cardiovascular risk factors including hypertension,diabetes / IGT or stroke than male patients.
引文
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[4]Canto JG,Kiefe CI,Rogers WJ,et al.Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction.JAMA,2011,306(19):2120-2127.
[5]姚远,梁峰,沈珠军.经皮冠状动脉介入治疗后冠心病心绞痛患者生存质量影响因素的分析.中国介入心脏病学杂志,2015,23(9):508-511.
[6]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentially modifiable risk factors associated with myocardial infarction in 52countries(the INTERHEART study):case-control study.Lancet,2004,364(9438):937-952.
[7]Kang HJ,Clare RM,Gao R,et al.Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome:A retrospective analysis from the Platelet Inhibition and Patient Outcomes(PLATO)trial.Am Heart J,2015,169(6):899-905.e1.
[8]Owsiak M,Pelc-Nowicka A,Badacz L,et al.Increased prevalence of cardiovascular risk factors in patients with acute coronarysyndrome and indications for treatment with oral anticoagulation.Kardiologia Polska,2011,69(9):907-912.
[9]Avezum A,Makdisse M,Spencer F,et al.Impact of age on management and outcome of acute coronary syndrome:observations from the global registry of acute coronary events(GRACE).Am Heart J,2005,149(1):67-73.
[10]刘军,赵冬,刘群,等.中国多省市急性冠状动脉综合征住院患者高胆固醇血症患病现况.中华心血管病杂志,2009,37(5):449-453.
[11]Hao K,Yasuda S,Takii T,et al.Urbanization,life style changes and the incidence/in-hospital mortality of acute myocardial infarction in Japan:report from the MIYAGI-AMI Registry Study.Circ J,2012,76(5):1136-1144.
[12]Yang HY,Huang JH,Hsu CY,et al.Gender differences and the trend in the acute myocardial infarction:a 10-year nationwide population-based analysis.SCI WORLD J,2011,2012(8):184075.
[13]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心血管病预防指南.中华心血管病杂志,2011,39(1):263-279.
[14]Nishiyama S,Watanabe T,Arimoto T,et al.Trends in coronary risk factors among patients with acute myocardial infarction over the last decade:the Yamagata AMI registry.J Atheroscler Thromb,2010,17(9):989-998.
[15]Yayan J.Association of traditional risk factors with coronary artery disease in nonagenarians:the primary role of hypertension.Clin Interv Aging,2014,9(9):2003-2012.
[16]Nallamothu BK,Normand SLT,Wang Y,et al.Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time:a retrospective study.Lancet,2015,385(9973):1114-1122.
[17]Sugiyama T,Hasegawa K,Kobayashi Y,et al.Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States,2001-2011.J Am Heart Assoc,2015,4(3):e001445.
[18]Owsiak M,Pelc-Nowicka A,Badacz L,et al.Increased prevalence of cardiovascular risk factors in patients with acute coronary syndrome and indications for treatment with oral anticoagulation.Kardiol Pol,2011,69(9):907-912.
[19]Nguyen HL,Ha DA,Phan DT,et al.Sex differences in clinical characteristics,hospital management practices,and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first Aacute myocardial infarction.PLo S One,2014,9(4):e95631.
[20]Roffi M,Radovanovic D,Erne P,et al.Gender-related mortality trends among diabetic patients with ST-segment elevation myocardial infarction:insights from a nationwide registry 1997-2010.Euro Heart J,2013,2(4):342-349.
[21]Papakonstantinou NA,Stamou MI,Baikoussis NG,et al.Sex differentiation with regard to coronary artery disease.J Cardiol,2013,62(1):4-11.
[22]Kyt9 V,SipilJ,Rautava P.Gender and in-hospital mortality of ST-segment elevation myocardial infarction(from a multihospital nationwide registry study of 31,689 patients).Am J Cardiol,2015,115(3):303-306.
[23]Pancholy SB,Shantha GP,Patel T,et al.Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention:a meta-analysis.JAMA Intern Med,2014,174(11):1822-1830.
[24]Mega JL,Hochman JS,Scirica BM,et al.Clinical features and outcomes of women with unstable ischemic heart disease:observations from metabolic efficiency with ranolazine for less ischemia in non-ST-elevation acute coronary syndromesthrombolysis in myocardial infarction 36(MERLIN-TIMI 36).Circulation,2010,121(16):1809-1817.
[25]Kambara H,Yamazaki T,Hayashi D,et al.Gender differences in patients with coronary artery disease in Japan:the Japanese Coronary Artery Disease Study(the JCAD study).Circ J,2009,73(5):912-917.
[2]National Institutes for Health,National Heart,Lung,and Blood Institute.Morbidity and Mortality:2007 Chartbook on Cardiovascular,Lung,and Blood Disease.Available at http://www.nhlbi.nih.gov/resources/docs/07-chtbk.pdf
[3]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2014》概要.中国循环杂志,2015,30(7):617-622.
[4]Canto JG,Kiefe CI,Rogers WJ,et al.Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction.JAMA,2011,306(19):2120-2127.
[5]姚远,梁峰,沈珠军.经皮冠状动脉介入治疗后冠心病心绞痛患者生存质量影响因素的分析.中国介入心脏病学杂志,2015,23(9):508-511.
[6]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentially modifiable risk factors associated with myocardial infarction in 52countries(the INTERHEART study):case-control study.Lancet,2004,364(9438):937-952.
[7]Kang HJ,Clare RM,Gao R,et al.Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome:A retrospective analysis from the Platelet Inhibition and Patient Outcomes(PLATO)trial.Am Heart J,2015,169(6):899-905.e1.
[8]Owsiak M,Pelc-Nowicka A,Badacz L,et al.Increased prevalence of cardiovascular risk factors in patients with acute coronarysyndrome and indications for treatment with oral anticoagulation.Kardiologia Polska,2011,69(9):907-912.
[9]Avezum A,Makdisse M,Spencer F,et al.Impact of age on management and outcome of acute coronary syndrome:observations from the global registry of acute coronary events(GRACE).Am Heart J,2005,149(1):67-73.
[10]刘军,赵冬,刘群,等.中国多省市急性冠状动脉综合征住院患者高胆固醇血症患病现况.中华心血管病杂志,2009,37(5):449-453.
[11]Hao K,Yasuda S,Takii T,et al.Urbanization,life style changes and the incidence/in-hospital mortality of acute myocardial infarction in Japan:report from the MIYAGI-AMI Registry Study.Circ J,2012,76(5):1136-1144.
[12]Yang HY,Huang JH,Hsu CY,et al.Gender differences and the trend in the acute myocardial infarction:a 10-year nationwide population-based analysis.SCI WORLD J,2011,2012(8):184075.
[13]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心血管病预防指南.中华心血管病杂志,2011,39(1):263-279.
[14]Nishiyama S,Watanabe T,Arimoto T,et al.Trends in coronary risk factors among patients with acute myocardial infarction over the last decade:the Yamagata AMI registry.J Atheroscler Thromb,2010,17(9):989-998.
[15]Yayan J.Association of traditional risk factors with coronary artery disease in nonagenarians:the primary role of hypertension.Clin Interv Aging,2014,9(9):2003-2012.
[16]Nallamothu BK,Normand SLT,Wang Y,et al.Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time:a retrospective study.Lancet,2015,385(9973):1114-1122.
[17]Sugiyama T,Hasegawa K,Kobayashi Y,et al.Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States,2001-2011.J Am Heart Assoc,2015,4(3):e001445.
[18]Owsiak M,Pelc-Nowicka A,Badacz L,et al.Increased prevalence of cardiovascular risk factors in patients with acute coronary syndrome and indications for treatment with oral anticoagulation.Kardiol Pol,2011,69(9):907-912.
[19]Nguyen HL,Ha DA,Phan DT,et al.Sex differences in clinical characteristics,hospital management practices,and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first Aacute myocardial infarction.PLo S One,2014,9(4):e95631.
[20]Roffi M,Radovanovic D,Erne P,et al.Gender-related mortality trends among diabetic patients with ST-segment elevation myocardial infarction:insights from a nationwide registry 1997-2010.Euro Heart J,2013,2(4):342-349.
[21]Papakonstantinou NA,Stamou MI,Baikoussis NG,et al.Sex differentiation with regard to coronary artery disease.J Cardiol,2013,62(1):4-11.
[22]Kyt9 V,SipilJ,Rautava P.Gender and in-hospital mortality of ST-segment elevation myocardial infarction(from a multihospital nationwide registry study of 31,689 patients).Am J Cardiol,2015,115(3):303-306.
[23]Pancholy SB,Shantha GP,Patel T,et al.Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention:a meta-analysis.JAMA Intern Med,2014,174(11):1822-1830.
[24]Mega JL,Hochman JS,Scirica BM,et al.Clinical features and outcomes of women with unstable ischemic heart disease:observations from metabolic efficiency with ranolazine for less ischemia in non-ST-elevation acute coronary syndromesthrombolysis in myocardial infarction 36(MERLIN-TIMI 36).Circulation,2010,121(16):1809-1817.
[25]Kambara H,Yamazaki T,Hayashi D,et al.Gender differences in patients with coronary artery disease in Japan:the Japanese Coronary Artery Disease Study(the JCAD study).Circ J,2009,73(5):912-917.