摘要
目的探讨经皮冠状动脉介入治疗(PCI)老年慢性完全闭塞(CTO)病变患者的营养状态与远期预后的关系。方法纳入2013年6月至2017年10月于西安交通大学第一附属医院346例行PCI的老年CTO病变患者,根据老年营养风险指数(GNRI)分为3组:无营养不良风险组(GNRI≥98,186例),营养不良低风险组(92≤GNRI<98,114例),营养不良中度/高度风险组(GNRI<92,46例)。主要终点事件为全因死亡,次要终点事件为心血管死亡。结果纳入的346例患者平均年龄为72岁,中位随访33个月,Kaplan-Meier生存分析显示,营养不良中/重度风险患者在全因死亡及心血管死亡方面的预后均比其他两组差(Log-rank检验,全因死亡:P=0.004,心血管死亡:P=0.003)。多因素Cox回归分析提示全因死亡与中/重度营养不良、淋巴细胞计数及左心室射血分数相关,心血管死亡只与中/重度营养不良相关。与无营养不良风险患者相比,营养不良中/重度风险患者全因死亡及心血管死亡风险显著增加(HR 2.580,95%CI 1.139~5.842,P=0.023;HR4.709,95%CI 1.321~16.787,P=0.017)。结论入院时GNRI是老年CTO病变患者PCI术后全因死亡及心血管死亡风险的独立预测指标。
Objective To investigate the relationship between nutritional status and the long-term prognosis after percutaneous coronary intervention(PCI)in elderly patients with chronic total occlusion(CTO).Methods This study included 346 elderly patients with CTO treated with PCI in ou hospital between June 2013 and October 2017.Based on the geriatric nutritional risk index(GNRI),all patients were divided into 3 groups:no malnutrition group(GNRI≥98,n=186),low risk of malnutrition group(92≤GNRI<98,n=114),and the moderate/high risk of malnutrition group(GNRI<92,n=46).The primary endpoint event was all-cause mortality and the secondary endpoint event was cardiovascular death.Results The mean age of the 346 patients was 72 years.At a median followup of 33 months,Kaplan-Meier curves showed that the moderate/high malnutrition risk group had a worse long-term prognosis for both all-cause and cardiovascular mortality than the other two groups(Log-rank analysis,all-cause mortality P=0.004,cardiac mortality P=0.003).Multivariate COX regression analysis suggested that all-cause mortality outcomes were associated with moderate/severe malnutrition,lymphocyte count and left ventricular ejection fraction;while the cardiovascular mortality outcome was associated with moderate/severe malnutrition only.The risk of all-cause mortality and cardiovascular mortality was significantly increased in the moderate/high risk group of malnutrition compared with patients without malnutrition(HR 2.580,95%CI 1.139-5.842,P=0.023;HR 4.709,95%CI 1.321-16.787,P=0.017).Conclusions GNRI nutritional index is an independent predictor of all-cause mortality and cardiovascular mortality after PCI in elderly CTO patients.
作者
尹文峰
李倩
任洋
吴岳
YIN Wen-feng;LI Qian;REN Yang;WU Yue(Department of Cardiovascular Medicine,the First Affi liated Hospital of Xi’an Jiaotong University,Xi’an 710049,China)
出处
《中国介入心脏病学杂志》
2022年第10期758-764,共7页
Chinese Journal of Interventional Cardiology
基金
国家自然科学基金项目(81800205)。
关键词
老年营养风险指数
冠状动脉慢性完全闭塞
经皮冠状动脉介入治疗
全因死亡
心血管死亡
Geriatric nutritional risk index
Chronic total coronary artery occlusion
Percutaneous coronary intervention
All-cause mortality
Cardiovascular mortality
