我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

老年冠心病患者冠脉残余病变对PCI术后发生再次血运重建的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2018年第1期
页码:
53-057,073
栏目:
临床研究
出版日期:
2017-10-10

文章信息/Info

Title:
Effect of coronary residual lesions on repeat revascularization after PCI in elderly patients with coronary heart disease
作者:
何晓全; 张婧薇; 范 琰; 陈夏欢; 黄 波; 王禹川; 刘梅林
（北京大学第一医院老年内科，北京100034）
Author(s):
HE Xiao-quan;  ZHANG Jing-wei;  FAN Yan;  CHEN Xia-huan;  HUANG Bo;  WANG Yu-chuan;  LIU Mei-lin
(Department of Geriatrics, First Hospital, Peking University, Beijing 100034, China)
关键词:
老年; 经皮冠状动脉介入治疗; 再次血运重建; 残余病变
Keywords:
elderly; percutaneous coronary intervention; repeat revascularization;  residual lesion
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 研究冠脉残余病变对老年冠心病患者经皮冠状动脉介入（PCI）治疗术后发生再次血运重建的影响。方法 入选我院老年科行冠状动脉支架植入的≥60岁患者315例。中位随访时间为62（65±42）个月。应用SYNTAX积分系统定量判定PCI后残余病变，即残余SYNTAX积分（Residual SYNTAX score,rSS），简单线性回归分析rSS与基线SYNTAX积分（baseline SYNTAX score,bSS）的相关性。比较所有发生再次血运重建患者与未发生再次血运重建患者的基本资料，逐步回归分析rSS与总体血运重建的相关性。根据rSS水平进行3分组，即完全血运重建（Complete revascularization,CR）组（rSS=0），rSS低分组（08），比较不同rSS分组间PCI后再次血运重建累积发生率的差异。结果 老年冠心病患者rSS与bSS呈直线相关性，并且rSS是老年冠心病患者PCI后发生再次血运重建的相关危险因素。不同rSS分组间发生再次血运重建的累积发生率存在统计学差异（P<0.01），rSS高分组与rSS低分组和CR组存在显著差异（均P<0.01），而rSS低分组与CR组无统计学差异。结论 老年冠心病患者PCI术后残余病变是老年冠心病患者PCI后再次血运重建的危险因素，残余病变较重患者（rSS>8）比残余病变较轻（0
Abstract:
AIM To analyze the effect of residual coronary artery lesions on repeat revascularization after PCI in elderly patients with coronary heart disease. METHODS A total of 315 patients at Peking University First Hospital Geriatrics were enrolled, aged 60-99 (72.89±7.80) years.The median follow-up was 62 months. The SYNTA score system was utilized to quantitatively determine residual lesions after PCI as residual SYNTAX score (rSS). The correlation between rSS and baseline SYNTAX score (bSS) was analyzed by simple linear regression analysis. Data of patients experiencing repeat revascularization and those who did not experience repeat revascularization were compared. The correlation between rSS and total revascularization was analyzed by stepwise regression analysis. All patients were grouped according to levels of rSS as CR group (rSS=0), rSS lower group (rSS≥8 but>0) and rSS higher group (r>8). The cumulative incidence of repeat revascularization after PCI was compared between different groups. RESULTSRS S was linearly correlated with bSS and was a risk factor associated with repeat revascularization in elderly patients with coronary artery disease after PCI. There were statistical differences between rSS groups in the cumulative incidence of revascularization (P<0.01). Comparison revealed that the higher rSS group was significantly different from the lower rSS group (P<0.01) and the CR group (P<0.01). There were no significant differences between lower rSS and CR groups. CONCLUSION Residual lesions are a risk factor for repeat revascularization after PCI in elderly patients with coronary heart disease and the risk of repeat revascularization in patients with heavier residual disease (rSS>8) was significantly higher than that with less residual disease (0

参考文献/References

[1]Kim YH,Park DW,Lee JY,et al.Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease[J].Circulation,2011,123(21):2373-2381.

[2]Mj VDB,Rensing BJ,Morel MA,et al.The effect of completeness of revascularization on event-free survival at one year in the ARTS trial[J].J Am Coll Cardiol,2002,39(4):559-564.

[3]Shaw LJ,Berman DS,Maron DJ,et al.Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden - Results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy[J].Circulation,2008,117(10):1283.

[4]Sianos G,Morel M,Kappetein AP,et al.The SYNTAX Score:an angiographic tool grading the complexity of coronary artery disease.[J].EuroIntervention,2005,1(2):219-227.

[5]Kolh P,Windecker S,Alfonso F,et al.2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS).Developed with the special contribution[J].Eur J Cardiothorac Surg,2014,46(4):517.

[6]Généreux P,Palmerini T,Caixeta A,et al.Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention: The Residual SYNTAX(Synergy Between PCI With Taxus and Cardiac Surgery)Score[J].J Am Coll Cardiol,2012,59(24):2165-2174.

[7]Ma YC,Zuo L,Chen JH,et al.Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J].J Am Soc Nephrol,2006,17(10):2937-2944.

[8]Kastrati A,Sch?mig A,Elezi S,et al.Predictive factors of restenosis after coronary stent placement[J].J Am Coll Cardiol,1997,30(6):1428-1436.

[9]王新德.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.

[10]Tamburino C,Angiolillo DJ,Capranzano P,et al.Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary intervention with drug-eluting stents.[J].Catheter Cardiovasc Interv,2008,72(4):448-456.

[11]Kolh P,Windecker S,Alfonso F,et al.2014 ESC/EACTS Guidelines on myocardial revascularization:the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC)and the European Association for Cardio-Thoracic Surgery(EACTS).Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI).[J].Eur J Cardiothorac Surg,2014,46(4):517-592.

[12]Malkin CJ,Ghobrial MSA,Raina T,et al.046 Impact of incomplete revascularisation in patients undergoing PCI for unprotected left main stem stenosis[J].Catheter Cardiovasc Interv,2013,81(6):939-946.

[13]Farooq V.Quantification of incomplete revascularisation and its association with 5-year mortality in the synergy between PCI with Taxus and cardiac surgery trial:validation of the residual SYNTAX score[J].Circulation,2014,129(8):355-356.

[14]Park KW,Yoon J,Kim J,et al.Efficacy of Xience/promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) trial: study design and rationale of a Korean multicenter prospective randomized trial[J].Am Heart J,2009,157(5):811-817.

[15]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines:developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.[J].Catheter Cardiovasc Interv,2013,82(1):E1-E27.

[16]Wald DS,Morris JK,Wald NJ,et al.Randomized trial of preventive angioplasty in myocardial infarction[J].N Engl J Med,2013,369(12):1115-1123.

[17]Gershlick AH,Khan JN,Kelly DJ,et al.Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease:the CvLPRIT trial[J].J Am Coll Cardiol,2015,65(10):963-972.

[18]Engstrom T,Kelbaek H,Helqvist S,et al.Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease(DANAMI-3-PRIMULTI):an open-label, randomised controlled trial[J].Lancet,2015,386(9994):665-671.

[19]Sarathy K,Nagaraja V,Kapur A,et al.Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction:a meta-analysis of randomised trials[J].Heart Lung Circ,2015,24(4):327-334.

备注/Memo

备注/Memo:
收稿日期：2017-04-10.通讯作者：刘梅林，教授，主要从事冠心病、高脂血症和高血压病研究 Email：liumeili@hotmail.com 作者简介：何晓全，住院医师，博士 Email：heart_hexq@163.com
更新日期/Last Update: 1900-01-01