王国位,刘宏斌

• 1:兰州军区乌鲁木齐总医院心内科
• 2:中国人民解放军总医院心内科

摘要(Abstract)：

目的研究冠心病患者远期主要心脑血管事件(MACCE)的发生率及危险因素。方法对2004年1月至2006年3月连续就诊于解放军总医院心内科,经冠状动脉血运重建治疗(冠动状脉介入治疗或冠状动脉旁路移植术)的冠心病患者426例进行电话、再住院及信访调查,为单中心非对照登记研究;观察患者的临床特点、检查指标、手术资料对主要心脑血管事件发生的影响。主要终点:MACCE[包括全因死亡、再次心肌梗死(Re-MI)、靶病变/靶血管再次血运重建(TVR/TLR)、脑血管意外]发生情况;次要终点:心绞痛复发和非靶病变/靶血管再次血运重建(非TVR/TLR)。结果 426例冠心病患者成功完成6年的临床随访,平均随访时间(60.59±6.15)个月,中位随访时间60个月。6年MACCE累计发生84例(19.7%),其中Re-MI33例(7.7%)、TVR/TLR48例(11.3%)、全因死亡20例(4.7%)、心性死亡15例(3.5%),次要终点心绞痛复发139例(32.6%),非TVR/TLR23例(5.4%)。Cox回归模型分析显示陈旧性心肌梗死(OMI)(β=3.98,OR=53.47,95%CI3.59～795.74,P=0.004,)、卒中史(β=5.43,OR=228.31,95%CI8.21～635.36,P=0.001)、心律失常史(β=6.37,OR=586.44,95%CI5.44～6319.54,P=0.008)、吸烟史(β=1.6,OR=4.95,95%CI1.34～18.31,P=0.016)、高血压病史(β=2.78,OR=16.18,95%CI2.75～95.04,P=0.002)、病变血管数(β=3.029,OR=20.67,95%CI3.056～139.829,P=0.002)为MACCE发生的主要影响因素。生存曲线在术后第1年和第4～5年下降较为明显。结论 OMI、心律失常史、卒中史、高血压病史及病变血管数协同影响着本人群的远期预后。术后第1年和第4～5年间可能是MACCE高发的两个"时间窗"。

关键词(KeyWords)： 冠心病;预后;随访研究;Cox回归模型

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王国位,刘宏斌

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