冠状动脉临界狭窄病变药物治疗和介入治疗的长期疗效对比研究
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摘要
目的:评估比较非ST段抬高急性冠脉综合征(UA/NSTMI)患者择期冠状动脉造影示冠状动脉临界狭窄病变的介入治疗与药物治疗的长期疗效,寻找主要不良心脏事件(MACE)的良好预测因子,以指导临床应用。
方法:对222例UA/NSTMI患者进行择期冠状动脉造影术(CAG),均存在1处冠状动脉临界狭窄病变(直径狭窄率40～70%),按照是否对上述病变行介入治疗,分为介入治疗组(PCI组)和药物治疗组(MT组)。所有患者主要冠状动脉的严重病变(直径狭窄率≥75%)均给予PCI治疗。平均随访30个月,按照指南给予适宜的冠心病二级预防的指导治疗,观察随访期内心绞痛和MACE(非致命的性心梗、靶血管再成形术、心源性死亡)的发生状况。
结果:222例UA/NSTMI患者,PCI组(110例)与MT组(112例)临界狭窄病变平均狭窄率分别为54.7±9.3%和54.6±6.8%,组间比较无显著差异。两组患者的基本临床特征的组间比较,也无显著差异。平均随访30.05±10.99个月,尽管给予相同的二级预防干预,PCI组戒烟、规律运动、氯吡格雷、他汀类药物的应用及血脂达标明显高于MT组。本组人群共发生MACE34例(15%),PCI组和MT组MACE发生率分别为18.2%和12.5%,稳定性心绞痛的发生率分别47.3%和53.6%,组间比较均无显著统计学差异(P＜0.01),TIMI中危患者中PCI组的靶血管重建率为明显高于MT组(P=0.025)。根据MACE进行Logistic回归分析,临界狭窄是否介入治疗对MACE无明显影响,UA/NSTMI发作时的TIMI积分每升高1分,30个月内发生MACE的几率增加约1.38倍。
结论:1、UA/NSTMI患者,临界狭窄病变处介入治疗不能降低MACE,尤其是TIMI中危组,反而增加了再灌注治疗率。2、UA/NSTMI发作时的TIMI积分对长期预后有较强的预测作用。3、应进一步加强冠心病二级预防教育,强化药物治疗的基础地位。
Objectives:
(1)To evaluate the clinical outcomes of patients with intermediate coronary lesions,comparing those who underwent PCI for the intermediate lesion to those who did not(MT);(2)to determine the predictive factors of major adverse clinical cardiac events(MACE)in follow-ups.
Methods:
A total of 222 patients(mean age 63±10 years),with non-ST segment elevation acute coronary syndrome(UA/NSTMI)who had at last one intermediate coronary lesions(diameter stenosis rate 40-70%)were included in the study.PCI of an intermediate lesion was underwented in a group of 110 patients(PCI group).And the other 112 patients were treated with medical treatment by guideline(MT group).In all patients serious coronary lesions (diameter stenosis rate≥75%)were treated with PCI.MACE(cardiac death, nonfatal myocardial infarction,a need for target lesion revascularization)and the presence of angina were evaluated in follow-ups.
Results:
There was no difference regarding the mean percent diameter stenosis (54.7±9.3%and 54.6±6.8%,P＜0.01)between the two groups.The clinical features between two groups are similar.Although With the similar secondary prevention of coronary heart disease,quiting smoking,regular exercise,having clopidogrel and statins using,and dyslipidemia controlling were higher in the PCI group compared with MT group(P＜0.05).At a mean follow--up of 30±11 months,the tolal occurrence of MACE and presence of angina were similar between groups.PCI group with moderate TIMI risk has more incidence of TLR than MT group.TIMI risk score is a predictive factor of MACE(hazard ratio 1.38, 95%CI1.057-1.800,P＜0.05).
Conclusions:
(1)In patients with UA/NSTMI,PCI for intermediate coronary lesions did not reduce the occurrence of angina and MACE,especially in those with moderate TIMI risk.(2)TIMI score is a very powerful predictive factor for long prognosis in UA/NSTMI patients.(3)The secondary prevention of coronary heart disease and medical treatments should be emphasized.
方法:对222例UA/NSTMI患者进行择期冠状动脉造影术(CAG),均存在1处冠状动脉临界狭窄病变(直径狭窄率40～70%),按照是否对上述病变行介入治疗,分为介入治疗组(PCI组)和药物治疗组(MT组)。所有患者主要冠状动脉的严重病变(直径狭窄率≥75%)均给予PCI治疗。平均随访30个月,按照指南给予适宜的冠心病二级预防的指导治疗,观察随访期内心绞痛和MACE(非致命的性心梗、靶血管再成形术、心源性死亡)的发生状况。
结果:222例UA/NSTMI患者,PCI组(110例)与MT组(112例)临界狭窄病变平均狭窄率分别为54.7±9.3%和54.6±6.8%,组间比较无显著差异。两组患者的基本临床特征的组间比较,也无显著差异。平均随访30.05±10.99个月,尽管给予相同的二级预防干预,PCI组戒烟、规律运动、氯吡格雷、他汀类药物的应用及血脂达标明显高于MT组。本组人群共发生MACE34例(15%),PCI组和MT组MACE发生率分别为18.2%和12.5%,稳定性心绞痛的发生率分别47.3%和53.6%,组间比较均无显著统计学差异(P＜0.01),TIMI中危患者中PCI组的靶血管重建率为明显高于MT组(P=0.025)。根据MACE进行Logistic回归分析,临界狭窄是否介入治疗对MACE无明显影响,UA/NSTMI发作时的TIMI积分每升高1分,30个月内发生MACE的几率增加约1.38倍。
结论:1、UA/NSTMI患者,临界狭窄病变处介入治疗不能降低MACE,尤其是TIMI中危组,反而增加了再灌注治疗率。2、UA/NSTMI发作时的TIMI积分对长期预后有较强的预测作用。3、应进一步加强冠心病二级预防教育,强化药物治疗的基础地位。
Objectives:
(1)To evaluate the clinical outcomes of patients with intermediate coronary lesions,comparing those who underwent PCI for the intermediate lesion to those who did not(MT);(2)to determine the predictive factors of major adverse clinical cardiac events(MACE)in follow-ups.
Methods:
A total of 222 patients(mean age 63±10 years),with non-ST segment elevation acute coronary syndrome(UA/NSTMI)who had at last one intermediate coronary lesions(diameter stenosis rate 40-70%)were included in the study.PCI of an intermediate lesion was underwented in a group of 110 patients(PCI group).And the other 112 patients were treated with medical treatment by guideline(MT group).In all patients serious coronary lesions (diameter stenosis rate≥75%)were treated with PCI.MACE(cardiac death, nonfatal myocardial infarction,a need for target lesion revascularization)and the presence of angina were evaluated in follow-ups.
Results:
There was no difference regarding the mean percent diameter stenosis (54.7±9.3%and 54.6±6.8%,P＜0.01)between the two groups.The clinical features between two groups are similar.Although With the similar secondary prevention of coronary heart disease,quiting smoking,regular exercise,having clopidogrel and statins using,and dyslipidemia controlling were higher in the PCI group compared with MT group(P＜0.05).At a mean follow--up of 30±11 months,the tolal occurrence of MACE and presence of angina were similar between groups.PCI group with moderate TIMI risk has more incidence of TLR than MT group.TIMI risk score is a predictive factor of MACE(hazard ratio 1.38, 95%CI1.057-1.800,P＜0.05).
Conclusions:
(1)In patients with UA/NSTMI,PCI for intermediate coronary lesions did not reduce the occurrence of angina and MACE,especially in those with moderate TIMI risk.(2)TIMI score is a very powerful predictive factor for long prognosis in UA/NSTMI patients.(3)The secondary prevention of coronary heart disease and medical treatments should be emphasized.
引文
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