冠心病介入术后预后及其影响因素分析
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摘要
目的
回顾性分析天津市胸科医院2006年1月至12月间连续确诊为冠心病且经过支架治疗的住院患者,了解患者出院后再发心血管事件与冠心病危险因素、血生化指标、心脏彩超指标、支架选择、药物治疗状况的相关关系,分析心脏介入术后发生心血管事件的影响因素。
对象及方法
1.研究对象:选择在2006年1月至12月间,天津市胸科医院行冠脉造影(CAG)患者共计5403例,其中确诊为冠心病者3162例,行PCI患者1495例,以其中PCI患者及病例、随访资料完整的1367例冠心病患者为研究对象。
2.研究内容:患者一般资料、危险因素(吸烟、高血压、糖尿病、家族史)、血液生化指标、住院超声心动图指标(左室射血分数、左室舒张末期内径)、支架类型、药物治疗情况及终点事件。
3.随诊方式:采用门诊复查及电话随访的方法,以电话随访为主,自2007年4月至2007年9月间电话随访患者,随访内容包括死亡、再发心血管事件、出院后用药(冠心病二级预防药物)等。
4.研究终点定义:所有原因死亡,心血管疾病死亡、非致死性心肌梗死、充血性心力衰竭、不稳定心绞痛、再次PCI或CABG。
5.统计学方法:采用SPSS 13.0统计软件,两组间比较采用卡方(x~2)检验或Fishers精确检验,计量资料以(?)±s表示,并应用t检验,P＜0.05有显著的统计学差异。
结果
1.一般资料:冠心病患者平均年龄60.24±10.32岁(27～86岁,呈正态分布),男性956例,年龄58.57±10.70岁;女性411例,年龄64.10±8.16岁,共208例患者在随访期出现终点事件。年龄在60岁以上的患者744例,出现终点事件率明显高于60岁以下患者(20.70%vs.8.67%,P＜0.01),且女性终点事件再发率略高于男性(18.00%vs.14.02%,P=0.071)。
2.危险因素:随访结果显示大多数患者存在冠心病危险因素。有吸烟史的患者占58.89%(805/1367),有高血压病史患者占58.81%(804/1367),有糖尿病史的患者占20.12%(275/1367),血脂紊乱患者22.68%(310/1367)。经x~2检验分析,吸烟高血压及糖尿病在出院后发生终点事件与未发生事件的患者人群有显著统计学差异(P均＜0.05)。
3.随访情况:平均随访时间为13.38±3.13月,随访到1367份资料完整患者,随访率为91.44%,发生心血管事件208例,发生率为15.22%,出院后长期坚持服用抗血小板药物的患者达85.95%,服用他汀类药物少于3个月的患者有312例,使用时间介入3～9个月间的患者758例,使用时间大于9个月者297例,长期服用他汀类药物的患者少于其他冠心病二级预防药物。
4.血液生化指标:住院期间的生化参数在随访期间发生和未发生终点事件的患者人群中有显著统计学差异(总胆固醇、甘油三脂、低密度脂蛋白胆固醇、空腹血糖)。患者高密度脂蛋白水平对预后未见明显统计学差异。
5.患者介入治疗后的终点事件发生与冠心病患者病变类型、受累病变支数、置入支架的种类相关。
结论
患者接受经皮冠状动脉腔内成形术及支架置入术的患者总体预后良好。置入支架后,冠心病的传统危险因素吸烟、糖尿病、高脂血症等情况仍需加以控制,以减少心脏不良事件的发生。
Objective
This case control study is designed to analyze the effect of cardiovascular risk factors, blood biochemistry parameters, echocardiographic parameters, stent parameters, in the prognosis of coronary heart disease during long-term following-up in patients admitted to Tianjin Chest Hospital and received PCI treatment during 2006. and further analysis can be laid to study cardio-incidence after PCI treatment.
Target and Methods
1. Study patients: 5403 consequentive in-patients were accepted CAG were selected, including3162 patients with definite diagnosis of CHD, and 1495 patients were received PCI treatment during 2006. After review of inclusion and exclusion criteria, 1367 patients experienced PCI inhospital, and satisfying both criteria were ultimately enrolled in the present study.
2. Study content: The date of demography, cardiovascular risk factors (smoke, hypertension, diabetes, family history, blood biochemistry, inhospital echocardiographic measurements ( LVEF、LVEDD ), diameter and length of the stents, the pharmacological treatment were collected and correlated with the cardiovascular events occurred during following-up period.
3. Follow-up methods: The following-up methods used in this study included: telephone consultation and clinic consultation. And the main method was the former. The items of follow-up included death, recurrence of cardiovascular events, after hospital discharge drug treatment, etc.
4. The definition of end-points: The end-points used in this study include all cause deaths, cardiogenic deaths, non-fatal MI, congestive heart disease, unstable angina, revascularization (PCI or CABG)
5. Statistic method: Analyze the data used the statistic software SPSS 13.0. Chi square test or Fishers exact test were used to compare numeration data between groups. Scale data were expressed with mean±SD, T test was used to compare scale data between two groups. Logistic analysis was conducted to detect risk factor's impact on the prognosis of cardiovascular events. P < 0.05 was considered to be statistic significance.
Results
1. Demography data: The mean age of all 1367 selected CHD patients is 60.24±10.32 years old, the mean age of 956 male patients is 58.57±10.70; the mean age of 411 female patients is 64.10±8.16. There are 208 patients recurrence of cardiovascular events totally. 744 patients' age is above 60.
2. Risk factors: Most patients in the follow-up study had CHD risk factors. The risk factor in this cohort patients included smoking (58.89%, 805/1367), hypertension (58.81%, 804/1367), diabetes (20.12%, 275/1367) and lipid disorders (22.68%, 310/1367). The distributions of various risk factors including smoke, hypertension, diabetes were significantly different between the group with and without cardiovascular events (P<0.05).
3. Folio wing-up: The patients were followed for 10-21 months, with the mean following-up period of 13.38±2.13 months, the rate of following-up population was 91.44%, 208 patients happened to cardiovascular events and takes a rate of 15.22%; 85.95% of the patients were insisting on taking aspirin. There are only 312 patients adhered to statin treatment less than 3 months, and 758 patients during 3 to 9 months, only 297 patients were receipted last more than 9 months.
4. Blood biochemical indicators: There are significant difference between groups with and without events during follow-up in terms of following blood biochemical parameters inhospital: TC, TG, LDL-C, GLU, however no significant difference in HDL-C.
5. It's significant correlated between the type of CHD, the number of cardiovascular involved in, the type of stents planted in and the end-point events.
ConcIusion
The patients accepted PTCA and PCI showed well prognosis during the following-up. Traditional risk factors including smoking, DM, hyper blood lipids should be under control to limit the incidence rate of cardio-vascular events.
回顾性分析天津市胸科医院2006年1月至12月间连续确诊为冠心病且经过支架治疗的住院患者,了解患者出院后再发心血管事件与冠心病危险因素、血生化指标、心脏彩超指标、支架选择、药物治疗状况的相关关系,分析心脏介入术后发生心血管事件的影响因素。
对象及方法
1.研究对象:选择在2006年1月至12月间,天津市胸科医院行冠脉造影(CAG)患者共计5403例,其中确诊为冠心病者3162例,行PCI患者1495例,以其中PCI患者及病例、随访资料完整的1367例冠心病患者为研究对象。
2.研究内容:患者一般资料、危险因素(吸烟、高血压、糖尿病、家族史)、血液生化指标、住院超声心动图指标(左室射血分数、左室舒张末期内径)、支架类型、药物治疗情况及终点事件。
3.随诊方式:采用门诊复查及电话随访的方法,以电话随访为主,自2007年4月至2007年9月间电话随访患者,随访内容包括死亡、再发心血管事件、出院后用药(冠心病二级预防药物)等。
4.研究终点定义:所有原因死亡,心血管疾病死亡、非致死性心肌梗死、充血性心力衰竭、不稳定心绞痛、再次PCI或CABG。
5.统计学方法:采用SPSS 13.0统计软件,两组间比较采用卡方(x~2)检验或Fishers精确检验,计量资料以(?)±s表示,并应用t检验,P＜0.05有显著的统计学差异。
结果
1.一般资料:冠心病患者平均年龄60.24±10.32岁(27～86岁,呈正态分布),男性956例,年龄58.57±10.70岁;女性411例,年龄64.10±8.16岁,共208例患者在随访期出现终点事件。年龄在60岁以上的患者744例,出现终点事件率明显高于60岁以下患者(20.70%vs.8.67%,P＜0.01),且女性终点事件再发率略高于男性(18.00%vs.14.02%,P=0.071)。
2.危险因素:随访结果显示大多数患者存在冠心病危险因素。有吸烟史的患者占58.89%(805/1367),有高血压病史患者占58.81%(804/1367),有糖尿病史的患者占20.12%(275/1367),血脂紊乱患者22.68%(310/1367)。经x~2检验分析,吸烟高血压及糖尿病在出院后发生终点事件与未发生事件的患者人群有显著统计学差异(P均＜0.05)。
3.随访情况:平均随访时间为13.38±3.13月,随访到1367份资料完整患者,随访率为91.44%,发生心血管事件208例,发生率为15.22%,出院后长期坚持服用抗血小板药物的患者达85.95%,服用他汀类药物少于3个月的患者有312例,使用时间介入3～9个月间的患者758例,使用时间大于9个月者297例,长期服用他汀类药物的患者少于其他冠心病二级预防药物。
4.血液生化指标:住院期间的生化参数在随访期间发生和未发生终点事件的患者人群中有显著统计学差异(总胆固醇、甘油三脂、低密度脂蛋白胆固醇、空腹血糖)。患者高密度脂蛋白水平对预后未见明显统计学差异。
5.患者介入治疗后的终点事件发生与冠心病患者病变类型、受累病变支数、置入支架的种类相关。
结论
患者接受经皮冠状动脉腔内成形术及支架置入术的患者总体预后良好。置入支架后,冠心病的传统危险因素吸烟、糖尿病、高脂血症等情况仍需加以控制,以减少心脏不良事件的发生。
Objective
This case control study is designed to analyze the effect of cardiovascular risk factors, blood biochemistry parameters, echocardiographic parameters, stent parameters, in the prognosis of coronary heart disease during long-term following-up in patients admitted to Tianjin Chest Hospital and received PCI treatment during 2006. and further analysis can be laid to study cardio-incidence after PCI treatment.
Target and Methods
1. Study patients: 5403 consequentive in-patients were accepted CAG were selected, including3162 patients with definite diagnosis of CHD, and 1495 patients were received PCI treatment during 2006. After review of inclusion and exclusion criteria, 1367 patients experienced PCI inhospital, and satisfying both criteria were ultimately enrolled in the present study.
2. Study content: The date of demography, cardiovascular risk factors (smoke, hypertension, diabetes, family history, blood biochemistry, inhospital echocardiographic measurements ( LVEF、LVEDD ), diameter and length of the stents, the pharmacological treatment were collected and correlated with the cardiovascular events occurred during following-up period.
3. Follow-up methods: The following-up methods used in this study included: telephone consultation and clinic consultation. And the main method was the former. The items of follow-up included death, recurrence of cardiovascular events, after hospital discharge drug treatment, etc.
4. The definition of end-points: The end-points used in this study include all cause deaths, cardiogenic deaths, non-fatal MI, congestive heart disease, unstable angina, revascularization (PCI or CABG)
5. Statistic method: Analyze the data used the statistic software SPSS 13.0. Chi square test or Fishers exact test were used to compare numeration data between groups. Scale data were expressed with mean±SD, T test was used to compare scale data between two groups. Logistic analysis was conducted to detect risk factor's impact on the prognosis of cardiovascular events. P < 0.05 was considered to be statistic significance.
Results
1. Demography data: The mean age of all 1367 selected CHD patients is 60.24±10.32 years old, the mean age of 956 male patients is 58.57±10.70; the mean age of 411 female patients is 64.10±8.16. There are 208 patients recurrence of cardiovascular events totally. 744 patients' age is above 60.
2. Risk factors: Most patients in the follow-up study had CHD risk factors. The risk factor in this cohort patients included smoking (58.89%, 805/1367), hypertension (58.81%, 804/1367), diabetes (20.12%, 275/1367) and lipid disorders (22.68%, 310/1367). The distributions of various risk factors including smoke, hypertension, diabetes were significantly different between the group with and without cardiovascular events (P<0.05).
3. Folio wing-up: The patients were followed for 10-21 months, with the mean following-up period of 13.38±2.13 months, the rate of following-up population was 91.44%, 208 patients happened to cardiovascular events and takes a rate of 15.22%; 85.95% of the patients were insisting on taking aspirin. There are only 312 patients adhered to statin treatment less than 3 months, and 758 patients during 3 to 9 months, only 297 patients were receipted last more than 9 months.
4. Blood biochemical indicators: There are significant difference between groups with and without events during follow-up in terms of following blood biochemical parameters inhospital: TC, TG, LDL-C, GLU, however no significant difference in HDL-C.
5. It's significant correlated between the type of CHD, the number of cardiovascular involved in, the type of stents planted in and the end-point events.
ConcIusion
The patients accepted PTCA and PCI showed well prognosis during the following-up. Traditional risk factors including smoking, DM, hyper blood lipids should be under control to limit the incidence rate of cardio-vascular events.
引文
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