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结缔组织病患者PCI的短期和长期预后 作者：作者：Li Zhou,et al. 翻译：北医三院徐也 来源： 中国风湿病公众论坛 日期：2017-05-22  结缔组织病患者经皮冠状动脉介入治疗的短期和长期预后

背景:冠状动脉疾病（CAD）是结缔组织病患者发病和死亡的主要原因（CTDS）。相较于传统的冠状动脉疾病患者，合并结缔组织病的冠心病患者的危险因素和临床特征均不相同。本研究的目的是报告一系列接受经皮冠状动脉介入治疗（PCI）和支架植入术的患者的短期和长期的临床预后。

方法:研究组包括2009年1月至2012年6月间连续于北京友谊医院行PCI治疗的的106例CTD患者。病历回顾性分析的主要内容包括：临床基本资料、冠状动脉造影资料以及短期和长期（平均3年）随访期间的主要不良心脏事件发生率（MACEs）。

结果: 92名患者（86.8%）有一个或多个传统的CAD高危因素。超过2 / 3的患者（73.6%）为多支血管病变。左冠状动脉前降支最常见的受累血管（65.1%）。共植入5个金属支架和202个药物洗脱支架。中位随访期36个月后，13例患者（12.3%）死于心源性疾病，支架内血栓形成率为9.4%，和靶血管支架内再狭窄率（TVR）为14.2%。多因素分析显示，高血压（风险比[HR] = 3.07，95%可信区间[ CI]：1.30 - 7.24，P = 0.041），前壁心肌梗死（HR = 2.77，95% CI：1.06 - 7.03，P = 0.04），长期的降胆固醇治疗（HR = 3.60，95% CI：1.43，P = 0.032），和C 反应蛋白水平大于10毫克/升（HR = 3.98，95%可信区间：1.19 12.56，P = 0.036）均是主要心脏不良事件发生的独立预测因子。

结论:CTD合并CAD的患者可能有严重的冠状动脉病变。PCI术后的此类患者的长期随访中往往有更高的支架内血栓形成和TVR几率，传统和非传统冠心病高危因素可能均有影响。

 

 

 

Background:Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with connective tissue diseases (CTDs). Risk factors and clinical characteristics in these patients are not equivalent to those in traditional CAD patients. The objective of this study was to report short- and long-term clinical outcomes in a consecutive series of patients with CTD who underwent percutaneous coronary intervention (PCI) with stent implantation.

Methods:The study group comprised 106 consecutive patients with CTD who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2012. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse cardiac events (MACEs) during the short- and long-term (median 3 years) follow-up.

Results:Ninety-two of the patients (86.8%) had one or more traditional CAD risk factors. Multivessel disease was present in more than 2/3 of patients (73.6%). The left anterior descending coronary artery was the most commonly affected vessel (65.1%). Five bare-metal stents and 202 drug-eluting stents were implanted. After a median follow-up period of 36 months, thirteen patients (12.3%) died from cardiac causes, the rate of stent thrombosis was 9.4%, and the rate of target vessel revascularization (TVR) was 14.2%. Multivariate analysis revealed that hypertension (hazard ratio [HR] = 3.07, 95% confidence interval [CI]: 1.30 7.24, P = 0.041), anterior myocardial infarction (HR = 2.77, 95% CI: 1.06 7.03, P = 0.04), longer duration of steroid treatment (HR = 3.60, 95% CI: 1.43 9.08, P = 0.032), and C-reactive protein level 10 mg/L (HR = 3.98, 95% CI: 1.19 12.56, P = 0.036) were independent predictors of MACEs.

Conclusions:Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.

 

 

引自：Li Zhou, et，al，Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary Intervention。Chin Med J (Engl). 2016 Apr 5; 129(7): 804 808. doi:  10.4103/0366-6999.178956.