年龄对冠心病合并2型糖尿病患者经皮冠状动脉介入治疗预后的影响

摘要

Objective To investigate the effects of age on the prognosis of patients with coronary heart disease complicated with type 2 diabetes mellitus after treatment of percutaneous coronary intervention (PCI).Methods Patients with coronary heart disease complicated with type 2 diabetes mellitus (n =705) who underwent PCI therapy were divided into three groups according to their age:youth group (aged 18-59 years),old group (aged 60-74 years),and elderly group (aged ≥75 years).The clinical data were collected.All-cause death and major adverse cardiac events (cardiac death,unplanned revascularization,nonfatal myocardial infarction) were followed up after PCI therapy.COX regression model was used to investigate the prognostic evaluation of age.Results The ratios of male patients,previous history of smoking,and insulin use were lower in the elderly group than those of the youth group and old group,and the elderly group had higher ratios of previous history of hypertension and higher level of serum creatinine (all P ＜ 0.05).About the distribution of coronary disease,the single-vessel disease was higher in the youth group,2-vessel disease was higher in the elderly group,and the old group had a higher proportion of severe calcification lesion (all P ＜ 0.01).There was no significant difference in the incidence of all-cause death,cardiac death,nonfatal myocardial infarction,and unplanned revascularization between the three groups.COX regression model showed that age was not significantly correlated with all-cause mortality and major adverse cardiac events.Conclusion Age is not a predictor of adverse cardiovascular events after PCI in patients with coronary heart disease complicated with type 2 diabetes mellitus.%目的 观察年龄对行经皮冠状动脉介入(PCI)治疗的冠心病合并2型糖尿病患者预后的影响.方法 行PCI治疗的冠心病合并2型糖尿病患者705例,根据入院年龄将患者分为青年(年龄18～59岁)、老年(年龄60～ 74岁)、高龄(年龄≥75岁)三组.统计三组临床资料,随访术后临床终点事件,包括全因死亡、主要心血管不良事件(心源性死亡、非计划再次血运重建、非致死性心肌梗死),并使用COX回归模型分析年龄对冠心病合并2型糖尿病患者PCI治疗预后的影响.结果 高龄者中男性患者比例、既往吸烟史、使用胰岛素比例较青年、老年者低,既往合并高血压史、血肌酐水平较青年、老年者高(P均＜0.05).青年者冠脉单支血管病变比例高于老年、高龄者,高龄者双支病变比例较高,老年者冠脉中重度钙化比例高于青年、高龄者(P均＜0.01).三者术后全因死亡、心源性死亡、非计划再次血运重建及非致死性心肌梗死发生情况比较差异无统计学意义.单因素及多因素COX回归分析结果表明,年龄与全因死亡及主要心血管不良事件无明显相关.结论 年龄不是冠心病合并2型糖尿病患者PCI术后心血管不良事件的预测因素.