冠状动脉病变支架后非罪犯病变快速进展的预测因子

摘要

目的 旨在探讨冠状动脉(以下简称冠脉)非罪犯病变快速进展的预测因子.方法 连续收集2006年1月至2011年4月于罪犯病变部位成功置入支架共170例冠状动脉粥样硬化性心脏病(以下简称冠心病)患者的临床资料,术后1至12个月期间再次行冠脉造影,观察经皮冠状动脉介入(percutaneous coronary interventions,PCI)术时非罪犯冠脉病变的进展情况,根据这些病变的进展情况将所有患者分为快速进展组(n=49)和缓慢进展组(n=121).结果 在研究人群中,非罪犯病变的快速进展的患者占28%,这些患者应用他汀类药物治疗的比例相对较低,多支血管病变的比例较高.快速进展组的三酰甘油(triglyceride,TG)(2.02 vs 1.59 mmol/L,P=0.020)、总胆固醇(total cholesterol,TC) (4.25 vs 3.79 mmol/L,P=0.013)及TC的降低幅度(-0.80 vs-1.25 mmol/L,P=0.030)和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)(2.42 vs 2.16 mmol/L,P=0.030)及LDL-C的降低幅度(-0.39 vs-0.75 mmol/L,P=0.020)明显高于缓慢进展组.多因素Logistic回归分析显示,多支血管病变、TG浓度、LDL-C降低幅度、支架内再狭窄以及他汀类药物治疗均是非罪犯病变快速进展的独立预测因子.结论 多支血管病变、TG浓度、LDL-C降低幅度、支架内再狭窄以及他汀类药物治疗与非罪犯冠脉病变的快速进展存在相关性,这充分证明了冠心病患者成功PCI术后继续强化他汀治疗的必要性.%Objective The majority of cardiovascular evenls in palienls undergoing perculaneous coronary interventions (PCI) arise from the progression of non-culprit coronary lesions (NCL) during the follow-up period. The purpose of this study was to investigate the predictors related to the rapid progression of NCL of patients undergoing PCI. Methods Between Jan. 2006 and Apr 2011, 170 consecutive patients who underwent coronary angiograms again with a time interval from 1 to 12 months after successful stent implantation at culprit-lesion. The patients were divided into rapid progression group (n =49) and slow progression group (n = 121) according to definition of rapid progression. Results Twenty-eight percent of patients had rapid progression of non- lesions. Rapid progressors had higher percentage of multivessel diseases and statin therapy. At follow-up, a significant difference was observed between rapid progression group and slow progression group in triglyceride (TG) (2. 02 vs 1. 59 mmol/L, P = 0. 020) , total cholesterol (TC) (4. 25 vs 3. 79 mmol/L, P =0. 013) , and change of TC (-0. 80 vs - 1. 25 mmol/L, P =0. 03) , low-density lipoprotein cholesterol (LDL-C) (2. 42 vs 2. 16 mmol/L, P = 0. 03) and change of LDL-C (- 0. 39 vs - 0. 75 mmol/L, P = 0. 020) . Multivariate Logistic regression analysis revealed that multivessel diseases, on-treatment for TG, change of LDL-C, rate of in-stent restenosis and rate of statin therapy were independent predictors for rapid progression. Conclusion Multivessel diseases, on-treatment for TG, change of LDL-C, rate of in-stent restenosis and rate of statin therapy were associated with the rapid progression of non- coronary lesion. This finding highlights the need for intensive statins therapy in patients with coronary artery disease after successful PCI.