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目的了解无心血管危险因素的冠心病血管重建患者临床和冠状动脉病变特征及预后。方法入选2003年7月1日至2005年9月30日在北京安贞医院接受冠状动脉血管重建术(PCI或CABG)存活出院并完成随访的5461例患者,根据有无传统心血管危险因素分无危险因素组376例,有危险因素组5085例。记录患者临床基础资料、冠状动脉病变情况及随访期间死亡和主要不良心脑血管事件(MACCE)的发生。结果男性占76.9%(4199例),平均年龄(60.0±10.4)岁,平均随访549d。无危险因素患者年龄偏大、BMI低(P<0.000);冠状动脉单支、双支和三支病变率两组差异无统计学意义(P=0.120);血管开口病变、LAD近端、左主干和慢性闭塞病变两组差异无统计学意义;无危险因素组CABG患者多且完全血管重建率高(P=0.002)。随访2年,无事件生存率两组之间无统计学差异(88%vs.87%,P=0.061)。随访期间冠心病二级预防药物治疗中,无危险因素患者β受体阻滞剂、ACEI和他汀类药物使用率显著低于有危险因素组患者。结论无心血管危险因素的冠心病血管重建患者,尽管无传统心血管危险因素,但冠状动脉病变范围和程度与有危险因素者相同,一旦病变发展到需要做血运重建时,远期预后并不优于有危险因素的患者,而这些患者冠心病二级预防药物的使用率显著不足,提示临床上对于无危险因素的冠心病患者应同样重视和加强二级预防和治疗。
Objective To investigate the clinical features and prognosis of coronary artery disease in patients with coronary heart disease without cardiovascular risk factors. Methods A total of 5461 patients who underwent coronary revascularization (PCI or CABG) at Beijing Anzhen Hospital from July 1, 2003 to September 30, 2005 were discharged and completed follow-up. According to the presence or absence of traditional cardiovascular risk factors There were 376 cases without risk factors and 5085 cases with risk factors. The basic clinical data of patients, coronary artery disease and follow-up of death and major adverse cardiovascular events (MACCE) were recorded. Results Male accounted for 76.9% (4199 cases), mean age (60.0 ± 10.4) years, with an average follow-up of 549 days. Patients with no risk factors were older and had lower BMI (P <0.000). There was no significant difference in coronary artery single vessel, double vessel and triple vessel disease between the two groups (P = 0.120) There was no significant difference between the two groups in the main trunk and chronic occlusion lesions; in the non-risk factors group, more patients with complete CABG and complete revascularization (P = 0.002). There was no significant difference in event-free survival between the two groups at follow-up of 2 years (88% vs. 87%, P = 0.061). During the follow-up of secondary prevention of coronary heart disease in patients with no risk factors for β-blockers, ACEI and statin use was significantly lower than the risk group. Conclusions In patients with coronary heart disease who have no cardiovascular risk factors, the extent and extent of coronary artery disease are the same as those with risk factors, despite no traditional cardiovascular risk factors. The long-term prognosis is not as long as the disease progresses until revascularization is required Which is superior to patients with risk factors. However, the utilization rate of secondary prevention of coronary heart disease in these patients is not enough, which suggests that secondary prevention and treatment should be equally emphasized and strengthened in patients with coronary heart disease without risk factors.