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目的比较多支冠状动脉病变患者实施经皮冠状动脉介入术的不同血运重建方式(完全性或不完全性)对其远期预后的影响。方法540例冠心病患者行选择性冠状动脉内支架术,其中多支病变完全性血运重建组(CR组,247例),多支病变不完全性血运重建组(IR组,293例),对比分析两组患者经皮冠状动脉介入(PCI)术后远期随访结果。结果与CR组比较,IR组患者中冠状动脉病变处数、严重程度、三支病变比例、左主干病变、慢性闭塞病变、分叉病变数量均明显升高(P<0.05)。随访(32.4±2.4)个月,IR组左室射血分数明显低于CR组(P<0.05)。IR组再次血运重建比例和不良心血管事件(MACE)发生率均显著高于CR组(P<0.05)。Logistic回归分析发现不完全血运重建是MACE、再次血运重建的危险预测因子(P<0.05),但未见对远期死亡、再发心肌梗死的影响有统计学意义。结论通过行冠状动脉介入术实现完全性血运重建的冠状动脉多支病变患者长期预后效果优于不完全性血运重建者。不完全血运重建是MACE事件、再次血运重建的预测因子。
Objective To compare the effect of different revascularization methods (completeness or incompleteness) on the long-term prognosis of patients with multiple branches of coronary artery disease undergoing percutaneous coronary intervention. Methods 540 cases of coronary heart disease patients underwent selective coronary stenting, including multiple vessel lesion complete revascularization group (CR group, 247 cases), multiple vessel lesion incomplete revascularization group (IR group, 293 cases) , Comparative analysis of two groups of patients after percutaneous coronary intervention (PCI) postoperative long-term follow-up results. Results Compared with CR group, the number of coronary artery lesion, the severity, the proportion of three lesions, the number of left main trunk lesions, chronic occlusive lesions and bifurcation lesions in IR group were significantly increased (P <0.05). Follow-up (32.4 ± 2.4) months, left ventricular ejection fraction in IR group was significantly lower than that in CR group (P <0.05). The rate of revascularization and MACE in IR group were significantly higher than that in CR group (P <0.05). Logistic regression analysis showed that incomplete revascularization was a risk predictor of MACE and revascularization (P <0.05), but no significant effect on long-term mortality and recurrent myocardial infarction was found. Conclusion The long-term prognosis of patients with coronary artery disease complicated with complete revascularization by coronary intervention is superior to those with incomplete revascularization. Incomplete revascularization is a MACE event that predicts revascularization again.