冠心病三支病变不良预后患者临床特点与治疗策略分析

摘要

目的 探讨冠心病三支病变(three-vessel disease,T VD)预后不良患者的临床特点,以及经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)和单纯药物治疗等3种治疗方式对远期预后的影响,以期为临床治疗策略提供参考.方法 连续入组2004年4月至2011年2月在阜外医院入院的T VD患者8943例.对所收集的T VD患者大样本随访得到的1年主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular events,M ACCE)组和非M ACCE组进行临床因素和治疗策略对比分析.结果 与非M ACCE组相比,M ACCE组年龄更大、心肾功能更差、合并症包括糖尿病、卒中等更多,冠脉病变更复杂.校正多因素后,血肌酐水平、出院带药阿司匹林独立影响 M ACCE.M ACCE组和非 M ACCE组患者治疗策略存在明显差异(P< 0.01).M ACCE组血运重建显著少于非 M ACCE组(64.9% vs.76.2%,P<0.01),其中PCI组间无差异(46.1% vs.46.2%,P=0.533);差异来自M ACCE组CABG显著少于非MACCE组(18.8% vs.30.0%,P<0.01),而单纯药物治疗显著多于非MACCE组(35.1% vs.23.8%,P<0.01).结论 肾功能和服用阿司匹林是TVD患者心脑血管不良事件的独立影响因素.非MACCE组患者血运重建要显著多于MACCE组患者.血运重建可能是改善TVD患者预后的重要因素.%Objective To discuss the clinical characteristics of three-vessel coronary artery disease and how treatment strat-egy influences long-term outcome.Methods A total of 8 943 consecutive cases with three-vessel disease in a single center from April 2004 to February 2011 were prospectively collected.Major adverse cardiovascular and cerebrovascular events(MACCE)in-cluded all-cause death,acute myocardial infarction,revascularization,readmission and stroke.Clinical characteristics and treat-ment strategies were compared between MACCE group and non-MACCE group.Results As compared with non-MACCE group,patients in the MACCE group were associated with older age,worse cardiac and renal function,more comorbidities inclu-ding diabetes mellitus and stroke,more complicated coronary lesions.After multivariate adjustment,serum creatine level and dis-charge medication of aspirin were independent predictors for MACCE.Treatment strategy was significantly different between MACCE group and non-MACCE group(P<0.01).Revascularization rate was significantly lower in the MACCE group than in the non-MACCE group(64.9% vs.76.2%,P< 0.01).While PCI rate showed no difference between the two groups(46.1%vs.46.2%,P= 0.533).CABG rate was significantly lower in the MACCE group than in the non-MACCE group(18.8%vs.30.0%,P< 0.01).Pure medication therapy rate was significantly higher in the MACCE group than in the non-MACCE group(35.1% vs.23.8%,P<0.01).Conclusion Renal function and discharge medication of aspirin are independent predictors for MACCE in TVD patients.Revascularization is performed more frequently in MACCE group than in non-MACCE group sig-nificantly.Revascularization may be an important factor to improve outcome of TVD patients.