Objective The differences in clinical features and long-term major adverse cardiac events(major adverse cardiac events,MACE)were analyzed and compared between the complete revascularization(CR)and incomplete revascularization(IR)groups, in PCI-treated patients. Methods This study was a retrospective case analysis of a total of 250 patients from the intervention center of the cardiology department in the PLA General Hospital who had undergone successful PCI treatment from Jun 2004 to Mar 2006 and were followed-up successfully from Oct 2009 to Mar 2010 by telephone,outpatient visit or re-hospitalization. Patients were divided into 2 groups according to PCI-CR or IR,CR:(n=114 patients),IR:(n=136 patients). The baseline data,coronary artery lesion types and parameters related PCI operation were recorded and compared between groups. The long-term survival was analyzed by Kaplan-Meier table estimates and log-rank tests. Binary logistic regression eliminated the confounding factors of MACE. Results The average follow-up time was 5 years. No baseline data showed significant differences(P > 0.05)except for the family history of cardiovascular disease, which was lower in CR than in IR(P < 0.05). The complex lesion(B2+C)type distribution,the mean SYNTAX scores/implantation stent diameter and length were lower in CR than in IR(P<0.05).The endpoints:Total MACE and re-MI were significantly lower in CR than in IR(P<0.05);TVR/TLR and all-cause death showed the same results as the former but had no significant difference(P>0.05).The secondary point re-angina events in CR were significantly lower than those of IR(P<0.05). Kaplan-Meier survival analysis showed that the mean survival time and median-survival time were longer in CR and that the cumulative risk function of the IR curve was the upper limit of CR(P<0.05).Binary logistic regression analysis indicated that day-cigarette numbers(P < 0.05)and left ventricular systolic diameter(LVSD)(P < 0.05)were primary risk factors of MACE incidence after adjusting for possible confounding factors. Conclusion The CR strategy significantly improved survival quality as is as the rate of the cohorts with PCI-treatment during long-term follow-up. It will be more rational to prefer the CR strategy in practice where possible. A reduction in day-cigarette numbers and paying attention to LVSD change will have a positive impact on the prognosis of PCI patients.%目的 探讨经皮冠状动脉介入治疗(PCI)完全血运重建与否患者临床特点及远期预后的差异及影响因素.方法回顾性收集2004年1月 ~2006年3月在解放军总医院心血管介入中心PCI术后,通过电话、再住院及门诊成功随访的250例患者.根据冠状动脉病变是否完全血运重建分为PCI完全血运重建组(complete revascularization,CR)114例和非完全血运重建组(incomplete revascularization,IR)136例,记录基线资料、冠状动脉病变分型、PCI术相关参数.远期生存用Kaplan-Meier分析及Log-rank检验,Logistic 回归分析主要心血管不良事件(MACE)的影响因素.结果 两组基线除心血管病家族史(CR低于IR)外,余差异无统计学意义(P>0.05);冠状动脉病变分型及PCI术参数中,CR组复杂病变、SYNTAX评分、植入支架平均直径及长度低于IR组,差异有统计学意义(P < 0.05).主要终点:总MACE、再次心肌梗死发生率CR低于IR,差异有统计学意义(P <0.05),而TVR/TLR及死亡未达统计学意义(P>0.05);次要终点CR低于IR,差异有统计学意义(P<0.05).Kaplan-Meier分析提示CR平均生存时间及中位生存时间高于IR,累计危险函数CR曲线低于IR(P<0.05);二分类Logistic 回归分析经校正后示日吸烟数(P<0.05)及左室收缩末直径(LVSD)(P<0.05)为MACE发生的主要危险因素.结论 PCI 完全血运重建可显著改善远期生存质量及生存率,提示实践中尽可能实现CR,减少吸烟数量及关注LVSD变化将对PCI术后预后有一定意义.
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