影响老年冠心病患者血运重建术后死亡的危险因素

目的了解影响老年冠心病患者血运重建术后死亡的危险因素。方法在药物洗脱支架对血运重建影响研究（DESIRE）数据库中,人选2003年7月1日至2004年6月30日在我院接受冠状动脉血运重建术,年龄70岁以上,出院后随访〉30天的冠心病患者675例,男性498例,女性177例。记录患者的临床特点、随访期间死亡和主要不良心脑血管事件（MACCE）发生情况。结果平均随访（754±355）天。随访中死亡27例（4．0％）,发生MACCE50例（7．4％）,多因素Cox回归分析,校正其他因素后,与男性患者相比,女性患者死亡的危险为2．750（95％CI1．116—6．779,P=0．028）;合并贫血患者死亡危险为0．385（95％C10．164—0．904,P=0．028）;血肌酐（Cr）水平越高,死亡危险越大,肾功能减低者（Cr≥115μmol／L）死亡危险为2．963（95％ CI1．114～9．952．P=0．035）,肾功能不全者（Cry〉177μmol／L）死亡危险为10．785（95％CI 2．659～78．097,P=0．000）。结论影响血运重建后老年冠心病患者死亡的危险因素是性别、血运重建前血红蛋白和Cr水平。女性、贫血和肾功能减低的冠心病患者血运重建后远期预后不良,死亡率高。术前应认识这些危险因素并加以纠正,将有利于改善血运重建后老年冠心病患者的远期预后。

Risk factors related to mortality in old patients with coronary heart disease after revascularization

OBJECTIVE: To evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization. METHODS: A total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded. RESULTS: The patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors. CONCLUSION: Preexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.