摘要
目的分析冠状动脉无保护左主干(UPLM)病变的临床特点和介入治疗效果及预后。方法收集2012年1月至2013年7月在我院心内科接受UPLM病变介入治疗的70例患者的临床资料、介入治疗情况,并在其术后进行电话或门诊随访。分析这些患者的临床基本特点和介入治疗效果,探讨影响介入治疗临床预后的相关因素。结果 70例患者中男性74.3%,女性25.7%,平均年龄69.30±9.95岁。左心室射血分数(LVEF)平均为49.0%,肾小球滤过率估计值(e GFR)中位数为56 m L/(min·1.73 mm2),Syntax评分平均为26.5分,植入支架长度中位数为34 mm。所有患者平均随访13.3个月,Kaplan-Meier估算的主要不良心血管事件(MACE)累计发生率为24.5%,术后无严重出血并发症。单因素COX比例风险模型回归分析显示LVEF增高可显著降低MACE发生率(P=0.01),Syntax评分增高可显著增加MACE发生率(P=0.03);年龄≥70岁有增加MACE风险的趋势(P=0.053),e GFR升高有降低MACE风险的趋势(P=0.05)。多因素COX比例风险模型回归分析显示LVEF和e GFR对MACE发生率有预测作用(P=0.016和P=0.17),而Syntax评分以及年龄≥70岁这两个因素的作用被明显削弱。结论 UPLM病变的介入治疗是有效和安全的,LVEF和e GFR是术后MACE发生率的主要预测因素。
Aim To analyze the clinical characteristics,interventional therapy effect and prognosis for the 70 patients with unprotected left main coronary artery（ UPLM） lesion. Methods Clinical data of 70 patients who accepted the interventional therapy for UPLM lesion were collected from January 2012 to July 2013 in our hospital. Telephone or clinic follow-up was carried out after the operation. The clinical characteristics and effect of interventional therapy for patients were analyzed,and the related factors that influenced the clinical prognosis of interventional therapy were explored.Results The 70 patients included 74. 3% male and 25. 7% female. The average age was 69. 30 ± 9. 95 years. The average of the left ventricular ejection fraction（ LVEF） was 49. 0%. The median value of the estimated glomerular filtration rate（ e GFR） was 56 m L /（ min·1. 73 mm2）. The average Syntax score was 26. 5 and the median value of stents length was 34 mm. All patients were followed up for average of 13. 3 months. The cumulative incidence of the major adverse cardiovascular event（ MACE） estimated by Kaplan-Meier was 24. 5%. No severe hemorrhage complication was observed after inteventional therapy. Univariate regression analysis with COX proportional hazards model revealed that the increase of LVEF would decrease the incidence of MACE（ P = 0. 01）,and the elevation of Syntax score would increase the incidence of MACE（ P = 0. 03）. Age≥70 years tended to increase the incidence of MACE（ P = 0. 053）,while the increase of e GFR tended to reduce the incidence of MACE（ P = 0. 05）. Multivariate regression analysis with COX proportional hazards model demonstrated that LVEF and e GFR had predictive value for the MACE（ P = 0. 016 and P = 0. 17）,while the predictive effect of Syntax score and age≥70 years were attenuated. Conclusions The interventional therapy of UPLM disease is effective and safe. The LVEF and e GFR are the major predictors of the MACE.
出处
《中国动脉硬化杂志》
CAS
北大核心
2016年第2期193-197,共5页
Chinese Journal of Arteriosclerosis
关键词
冠状动脉无保护左主干病变
介入治疗
主要不良心血管事件
回归分析
左心室射血分数
肾小球滤过率估计值
Unprotected Left Main Coronary Artery Lesion
Interventional Therapy
Major Adverse Cardiovas cular Event
Regression Analysis
Left Ventricular Ejection Fraction
Estimated Glomerular Filtration Rate
