经皮冠状动脉介入术后患者冠状动脉非靶病变进展的相关因素分析

摘要

Objective To investigate the risk factors of non-target lesion progression in patients after percutaneous coronary intervention(PCI).Methods From January 2013 to December 2016,a total of 3 071 patients who underwent single-vessel PCI for acute coronary syndrome were enrolled in Beijing Anzhen Hospital,Capital Medical University.Remaining non-target stenoses were ＜ 50％.All patients were readmitted to hospital due to chest pain within 6 to 24 months after PCI.According to coronary angiography results at readmission,they were divided into group A(n =1 541) and group B(n =1 530);patients in group A had non-target lesion progression (stenoses ＞75％);non-target stenoses of patients in group B were ＜ 75％.Related clinical data and influence factors of non-target lesion progression were analyzed.Results There were no significant differences of body mass index,non-target stenosis degree,low-density lipoprotein cholesterol(LDL-C) level and LDL-C compliance rate of the first time hospitalization between groups (P ＞ 0.05).At admission of the second time hospitalization,body mass index,non-target lesion stenosis degree and LDL-C level in group B were significantly lower than those in groupA[(25.5±2.9)kg/m2vs (26.2±3.2)kg/m2,(49 ±12)％ vs (85±5)％,(1.9±0.6)mmol/L vs(2.2 ±0.8)mmol/L];normal body mass index ratio,LDL-C compliance rate and regular statins-taking rate in group B were significantly higher than those in group A [51.6％ (790/1 530) vs 35.3％ (544/1 541),43.7％ (668/1 530) vs 35.4％ (545/1 541),84.8％ (1 298/1 530) vs 60.9％ (938/1 541)] (all P ＜ 0.05).Conclusion Poor patient compliance such as unauthorized withdrawal or dose reduction of drugs,poor weight and blood lipid control are risk factors of non-target lesion progression in patients after PCI.%目的 探讨经皮冠状动脉介入(PCI)术后患者冠状动脉非靶病变进展的相关因素.方法 选取2013年1月至2016年12月于首都医科大学附属北京安贞医院住院因急性冠状动脉综合征行单支血管PCI治疗的患者3 071例,患者其余非靶病变狭窄均＜50％,并于6～24个月内因胸痛症状再次入院.根据再次住院时的冠状动脉造影三维重建定量分析将患者分为A组(1 541例)和B组(1 530例),A组为非靶病变进展患者(病变狭窄程度由原来的＜50％增加至＞75％),B组为非靶病变无进展患者(病变狭窄程度＜75％).比较2组患者2次入院的临床资料,分析非靶病变进展的影响因素.结果 第1次住院时,2组患者体重指数、非靶病变狭窄程度、低密度脂蛋白胆固醇(LDL-C)水平、LDL-C达标率比较,差异均无统计学意义(均P＞0.05).第2次住院时,B组体重指数、非靶病变狭窄程度、LDL-C水平明显低于A组[(25.5±2.9) kg/m2比(26.2±3.2) kg/m2 、(49±12)％比(85±5)％、(1.9±0.6)mmol/L比(2.2±0.8)mmol/L],体重指数正常范围比例、LDL-C达标率及PCI术后规律服用他汀类药物比例明显高于A组[51.6％ (790/1 530)比35.3％ (544/1 541)、43.7％ (668/1 530)比35.4％ (545/1 541)、84.8％(1 298/1 530)比60.9％ (938/1 541)],差异均有统计学意义(均P＜0.05).结论 患者的依从性差,包括擅自停药或减少药物剂量、体质量控制不佳、血脂控制不佳,是导致冠状动脉非靶病变进展的危险因素.