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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

19卷

期数:

2013年06期

页码:

459-463

栏目:

临床医学

出版日期:

2013-11-20

文章信息/Info

Title:

Prognostic factor analysis of percutaneous revascularization for patients with bypass grafts vascular stenosis

作者:

张 楠¹; 2; 王 林²; 石雨田²; 刘 寅²

1.天津医科大学研究生院，天津 300070；2.天津市胸科医院心内科，天津 300051

Author(s):

ZHANG Nan¹; 2 ;  WANG Lin²;  SHI Yu-tian²;  LIU Yin²

1.Graduate School, Tianjin Medical University, Tianjin 300070, China; 2.Department of Cardiology, Chest Hospital of Tianjin, Tianjin 300051, China

关键词:

冠状动脉搭桥术; 经皮冠状动脉介入治疗; 多因素危险因子; 预后随访

Keywords:

coronary artery bypass grafting;  percutaneous transluminal coronary intervention;  multiple risk factors prognosis;  follow-up

分类号:

R541.4

DOI:

-

文献标志码:

A

摘要:

目的：分析冠脉搭桥术后桥血管狭窄成功行介入治疗患者的基线资料特点，探讨原位血管及桥血管介入治疗、支架种类与桥血管狭窄行介入治疗患者预后的关系。方法：对入选的281例桥血管病变患者进行随访，统计基线资料，观察主要不良心血管事件（MACE）的情况，分为MACE组及无MACE组。对可疑影响MACE发生的危险因素行Logistic回归分析，得出影响该类人群预后的独立危险因素，采用Kaplan-Meier生存曲线Log-rank检验原位血管与桥血管介入治疗策略、药物涂层支架与裸支架对生存率的影响及区别。结果：在基线资料方面：年龄、性别、肥胖、高血压病史、吸烟史、高脂血症病史、冠心病家族史、既往心肌梗死病史、心功能情况及冠心病类型方面两组均无统计学差异（P＞0.05），在血糖、胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平中具有统计学差异（P值分别为0.003、0.021、0.014及0.014），糖尿病、HDL-C、支架直径及支架长度与桥血管介入治疗后发生MACE独立相关。原位血管组及桥血管组在发生MACE方面的差异具有统计学意义（P=0.008），在原位血管及桥血管介入治疗后随访的MACE中，药物洗脱支架（DES）与金属裸支架（BMS）组在MACE发生率中具有统计学差异。结论：糖尿病与支架长度是影响桥血管狭窄介入治疗预后的危险因素；HDL-C及支架直径为预后的保护因素；原位血管与桥血管的介入治疗策略比较中，原位血管的预后优于桥血管。

Abstract:

Objective: To analyze baseline information on characteristics of patients who had successful interventional therapy due to coronary artery bypass grafts’ stenosis after CABG, and discuss the relationship between interventional treatment in the native coronary arteries or the coronary artery bypass grafts and the prognosis, drug eluting stents and bare-metal stents. Methods: A retrospective analysis of 281 patients who got successful interventional treatment due to coronary artery bypass grafts’ stenosis after CABG was established. Baseline of the patients was compiled, followed up by the major adverse cardiovascular event (MACE) of the patients. According to the follow-up results of MACE, patients were divided into group MACE and group none MACE. Independent risk factors were concluded with regression analysis of the suspected risk factors of the MACE. The survival rate of interventional treatment in the native coronary artery and bypass grafts, drug eluting stents and bare-metal stents were analyzed by Kaplan-Meier survival curve. Results: No statistical differences (P> 0.05) were found between the two groups on baseline factors: age, gender, obesity, hypertension, smoking, hyperlipidemia, coronary heart disease and family history, previous MI, cardiac function and the type of coronary heart disease while related tests and examination of GLU, CHO, HDL-C, LDL-C level showed significant difference (P=0.003, 0.021, 0.014 and 0.014). Logistic regression analysis of suspected risk factors indicated diabetes mellitus, HDL-C, average diameter and total length of the stents led to the MACE after the intervention of CABG patients. The survival rate of the group native coronary artery and group bypass grafts showed significant difference (P = 0.008), and the difference between the group of drug eluting stents and bare stents in the incident rates of MACE were also statistically significant in the native coronary arteries and the coronary artery bypass grafts. Conclusion: Diabetes and length of stent are prognostic risk factors after interventional therapy due to the restenosis of coronary bypass grafts; HDL-C and diameter of the stent are protective factors for prognosis; The two groups of native coronary artery and bypass grafts follow difference treatment strategies,with the former superior to the latter on prognosis.

参考文献/References:

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备注/Memo

备注/Memo:

作者简介 张楠（1982-），男，主治医师，硕士在读，研究方向:心血管内科；通信作者:刘寅，E-mail: liuyin2088@126.com。

常用功能

更新日期/Last Update: 2013-12-20