SYNTAX积分对经皮冠状动脉介入治疗的临床疗效与预测作用研究

目的:研究SYNTAX积分、临床SYNTAX积分及Global Risk Classification(GRC)对左主干/3支病变的冠心病患者,经皮冠状动脉介入治疗术后临床的预测作用,并评价三种积分系统的预测价值。方法:回顾性分析自2007年1月31日至2008年12月31日,北京安贞医院心内科经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)置入Cypher select药物洗脱支架的左主干/3支病变的冠心病患者共190例。根据冠状动脉造影结果计算三种积分系统,并根据3分位数值分别分为低分、中分及高分组。通过门诊或电话随访PCI术后患者的主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE),包括死亡、非致命性心肌梗死、再次血运重建、脑血管事件发生率。分别评价三种积分系统对患者术后临床预后的预测作用,评价三者的预测能力。结果:190例患者中,失访10例,失访率5.3%,随访中位数为29.4个月,29例观察到MACCE,MACCE发生率18.5%。SYNTAX积分低分(≤20.5)、中分(21.0~31.0)及高分组(≥31.5)的主要MACCE发生率分别为9.1%、16.2%及30.9%。临床SYNTAX评分低分(≤19.5)、中分(19.6~29.1)及高分组(≥29.2)的主要MACCE率分别为14.9%、9.8%及30.6%。GRC低、中、高分组的MACCE发生率分别为17.8%、14.2%及46.1%,单因素及多因素分析结果均显示三种积分系统是MACCE的独立预测因子。ROC曲线分析结果 SYNTAX积分AUC=0.667(95%CI=0.564~0.770,P=0.004),临床SYNTAX积分AUC=0.636(95%CI=0.519~0.753,P=0.020),GRC预测PCI术后MACCE的能力(AUROC=0.617,95%CI=0.512~0.736,P=0.046),三者都显示对MACCE有预测价值。结论:三种积分系统对冠状动脉左主干/3支病变患者行PCI治疗后的MACCE均有预测作用,可作为MACCE的独立预测因子。     

依折麦布联合阿托伐他汀改善PCI后患者血脂代谢的临床研究

目的 观察依折麦布联合阿托伐他汀对经皮冠状动脉介入治疗(PCI)后患者血脂代谢的影响.方法 根据患者降脂治疗方案不同随机分为依折麦布联合阿托伐他汀组(依折麦布组)和单用阿托伐他汀组(阿托伐他汀组),治疗6个月后复查血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和血清高敏C反应蛋白(hs-CRP),比较两组主要不...     

甘油三酯葡萄糖乘积指数对急性冠状动脉综合征患者行急诊PCI术远期预后的预测价值

[目的]研究甘油三酯葡萄糖乘积(TyG)指数对急性冠状动脉综合征(ACS)患者行急诊经皮冠状动脉介入治疗(PCI)远期预后的预测价值。[方法]共纳入了2 249例行急诊PCI术的ACS患者,根据TyG指数的中位数将患者分为高TyG指数组及低TyG指数组。比较两组主要不良心脑血管事件(MACCE)发生情况。单因素及多因素Cox分析评价TyG对MACCE的预测价值,亚组分析评估TyG指数对MACCE预测价值的一致性。[结果]在66个月随访期间,共有299(13.3%)例患者发生MACCE。与低TyG指数组比,高TyG指数组的MACCE(17.1%比9.5%,P<0.001)、全因死亡(6.2%比3.7%,P=0.007)、心源性死亡(4.4%比2.1%,P=0.002)、非致死性心肌梗死(1.0%比0.3%,P=0.001)、非致死性缺血性卒中(2.0%比1.0%,P=0.039)和缺血驱使的血运重建(7.8%比4.8%,P=0.001)的发生率明显升高。多因素Cox分析显示TyG指数是MACCE的独立预测因子(HR 1.710,95%CI 1.304～2.242,P<0.00...     

Multimarker risk stratification approach and cardiovascular outcomes in patients with stable coronary artery disease undergoing elective percutaneous coronary intervention

AimsWe studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI).MethodsWe prospectively evaluated 302 consecutive patients with stable coronary artery disease and normal CPK-MB and cardiac troponin T levels, and who underwent elective PCI at our institution. The following cardiac biomarkers were measured before and between 12 and 24 h post-procedure: CK-MB, cardiac troponin T, hs-CRP, and NT-ProBNP. Patients were followed up for a minimum of 6 months.ResultsPost-PCI, CPK-MB levels were elevated but below myocardial infarction (MI) range in 70 patients (23%), and in the MI range in 6 patients (2%). Troponin T levels were detectable but below the 99th percentile (microleak) in 32 patients (10.6%) and elevated above the 99th percentile (periprocedural MI) in 104 patients (34.4%). At 9 months’ follow-up, 1% died, 2% had stable angina, 10.3% had non-fatal MI, and 87.7% remained asymptomatic. There was no significant difference in clinical events among groups stratified by elevation of one biomarker or multiple biomarkers.ConclusionSingle or multiple biomarker strategy in patients with normal baseline biomarkers failed to predict major cardiac events after PCI over medium-term follow-up.     

急性冠状动脉综合征患者经皮冠状动脉介入治疗成形术中血栓抽吸对术后1年心脏事件的影响

目的研究血栓抽吸技术对急性冠状动脉综合征(ACS)患者术后1年内心血管不良事件(MACE)的影响。方法 142例ACS患者随机行常规经皮冠状动脉介入治疗成形术(PCI)(59例)及PCI+血栓抽吸术(83例)。观察患者术中TIMI血流分级,左心室舒张末径、左心室射血分数和MACE发生情况。结果非ST段抬高型心肌梗死(NSTEMI)和STEMI患者行常规PCI组术后MACE发生率分别为50.0%和38.1%;血栓抽吸+PCI组术后MACE发生率分别为8.3%和11.1%,差异均有统计学意义(均为P<0.05)。结论 ACS患者在常规PCI术中联合血栓抽吸能降低术中无复流几率,减少患者术后MACE的发生。     

Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention: A retrospective study

BACKGROUNDFor patients with cardiovascular disease, blood pressure variability (BPV), distinct from hypertension, is an important determinant of adverse cardiac events. Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention (PCI) is to this point unclear. AIMTo investigate the relationship between blood pressure variability and outcomes for patients post-PCI. METHODSPatients undergoing PCI in a single state in 2017 were studied (n = 647). Systolic and diastolic BPV, defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis (n = 471). Adverse outcomes were identified up to a year following the procedure, including major adverse cardiac events (MACE), myocardial infarction, cerebrovascular accident, death, and all-cause hospitalization. RESULTSVisit-to-visit systolic BPV, as measured by both standard deviation and largest change, was higher in patients who had myocardial infarction, were readmitted, or died within one year following PCI. Systolic BPV, as measured by largest change or standard deviation, was higher in patients who had MACE, or readmissions (P < 0.05). Diastolic BPV, as measured by largest change, was higher in patients with MACE and readmissions (P < 0.05). CONCLUSIONAs BPV is easily measured and captured in the electronic medical record, these findings describe a novel method of identifying at-risk patients who undergo PCI. Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.     

急性ST段抬高型心肌梗死经皮冠状动脉介入治疗患者预后与平均血小板体积相关性研究

目的探讨术前平均血小板体积(MPV)与急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠脉介入治疗(PCI)患者预后的关系。方法选择STEMI行急诊PCI患者335例,根据入院时MPV水平分为A组(≤9.9 fl,123例)和B组(MPV>9.9 fl,212例)。对患者进行随访1年,观察主要心脏不良事件(MACE)发生率。根据MACE的发生,分为MACE(+)组和MACE(-)组,对两组数据进行分析。并对各因素采用Logistic回归分析。结果 MACE发生率B组[53例(25.0%)]高于A组[16例(13.0%)](χ2=6.844,P=0.01),主要表现在再发心绞痛[37例(17.4%)比9例(7.3%),χ2=6.751,P<0.01]和再次住院[40例(18.7%)比12例(9.7%),χ2=4.928,P=0.03]。MACE(+)组中MPV>9.9 fl病例比例高于MACE(-)组[54例(78.2%)比165例(62%),χ2=6.376,P=0.02]。多因素Logistic回归分析示MPV>9.9 fl(OR:2.05,P=0.03),提示MPV>9.9 fl与STEMI行急诊PCI患者1年预后相关。结论术前MPV>9.9 fl是预测STEMI行急诊PCI患者1年MACE的独立危险因素。     

抗氧化剂普罗布考对冠心病介入后患者主要不良心血管事件的Meta分析

目的评价抗氧化剂普罗布考对改善冠心病介入后患者主要不良心血管事件(MACE)的作用。方法检索PubMed、EMBASE、Science Direct和Cochrane临床对照试验中心注册库(the cochrane central register of clinical trial)、中文学术期刊全文数据库(CNKI)和万方数据库(WFDP)等电子数据库进行检索。中英文检索词包括抗氧化剂或普罗布考或维他命C或维他命E或N-乙酰半胱氨酸和血管成形术或支架和随机。采用Cochrane协作网提供的RevMan5.3软件进行Meta分析。结果在纳入的349篇文献中,有7篇文献对冠心病介入后患者发生MACE事件进行了报告,普罗布考组(n=352)发生MACE事件72例,发生率为20.5%;对照组(n=354)发生MACE事件111例,发生率为31.4%。与对照组比较,普罗布考组明显降低MAEC发生率(RR:0.65,95%CI 0.51～0.84,P=0.0008)。经进一步分析,与对照组比较,普罗布考组有52例患者发生再次血运重建事件,发生率为14.8%,显著低于对照组(86例,发生率为24.3%,95%CI 0.44～0.83,P=0.002)。两组再次心肌梗死和全因死亡率差异无显著性(P=0.34,P=0.49)。此外,与对照组比较,普罗布考组显著降低介入后患者总胆固醇和低密度脂蛋白水平(SMD-0.68, 95%CI-0.87～-0.49,P0.00001; SMD-0.28, 95%CI-0.46～-0.11,P=0.001)。结论与冠心病介入后常规治疗比较,抗氧化剂普罗布考联合常规治疗可明显降低MACE发生率,该作用与普罗布考降低再次血运重建,改善总胆固醇和低密度脂蛋白水平相关。     

氯吡格雷不同负荷方案对中低危ACS患者支架植入术的影响

目的探讨不同氯吡格雷在冠脉造影术前及术中负荷方式与剂量对中低危急性冠脉综合症(ACS)患者支架植入术后发生不良心血管事件的影响。方法入选279名患者,对照组114名患者,随机分为术前大于6小时氯吡格雷300mg负荷组65人、术中氯吡格雷300mg负荷组60人及术中氯吡格雷600mg负荷组40人。主要观察终点为术后30天内主要不良心血管事件(MACE)。结果各组间MACE事件发生无统计学差异(P=0.45);各组间ADP诱导最大血小板聚集率(ADP-PG)(P=0.05)和血清P-选择素(P=0.06)无统计学差异;术后均未出现大出血,术中600mg组出血发生率有升高趋势(P=0.28);支架平均直径(P=0.03)、术后TIMI血流分级(P=0.02)和术后最大ADP-PG(P=0.01)与MACE事件相关,而负荷方式、负荷剂量以及随访最大ADP-PG等与随访MACE无关。结论氯吡格雷术中负荷方式与术前负荷临床终点相似,600mg负荷剂量未进一步增加患者临床获益,且小出血发生有增加的趋势;如临床需要,在了解了患者冠脉情况后再予氯吡格雷负荷是一个安全且可以考虑的方法。     

急性冠状动脉综合征的急诊介入治疗

目的评价急诊冠状动脉内介入治疗急性冠状动脉综合征的疗效和安全性。方法急性冠状动脉综合征患者87例,男72例,女15例。年龄37～82岁。其中ST段抬高心肌梗死62例,非ST段抬高心肌梗死和不稳定型心绞痛25例,行急诊冠状动脉内介入治疗,分析其临床表现,冠状动脉病变特点,处理以及并发症和预后。结果87例患者共成功置入支架169枚,其中直接支架术53次,经皮冠状动脉腔内成形术加支架术116次。单纯冠状动脉腔内成形术22次。有16例患者行血管内超声指导冠状动脉内介入。手术成功率96．5％,住院期间死亡1例。随访5～22月,生存率98.8％,无事件生存率86．0％。院外猝死1例,心肌梗死1例,心绞痛再发10例。结论急诊冠状动脉内介入治疗急性冠状动脉综合征安全有效,有助于改善预后。     

Lipoprotein (a) is increased in acute coronary syndromes (unstable angina pectoris and myocardial infarction), but it is not predictive of the severity of coronary lesions

Lipoprotein (a) [Lp(a)] concentrations were determined in 365 patients undergoing coronary angiography for stable angina (n = 159), unstable angina (n = 99), recent myocardial infarction (n = 45), and nonischemic heart disease (cardiomyopathy or valvular disease, n = 62, non-IHD). Mean ± SD and median Lp(a) concentrations in stable angina (29.9 ± 29.2; 22 mg/dl) did not differ from those in non-IHD (26.9 ± 26.3; 17), but were significantly lower than in patients with unstable angina (52.7 ± 36.6; 58) and myocardial infarction (44.8 ± 36.4; 34) (p < 0.01). Coronary angiography revealed that 261 patients, including 4 patients in the non-IHD group, had significant (≥ 50%) coronary lesions. Lp(a) was higher in patients with (41 ± 35; 32) than in those without (28 ± 27; 19) angiographic evidence of significant coronary stenosis (p < 0.05) and showed a weak univariate correlation with the angiographic index (Total Score) of the severity of the disease (r = 0.106; p < 0.05). However, in the subgroup of 303 patients with stable/unstable angina or myocardial infarction, Lp(a) was predictive neither of angiographic presence nor of severity of coronary disease. Patients were then ranked according to the Total Score values. Among patients with comparable angiographic severity of coronary artery disease, Lp(a) appeared to be remarkably higher in patients with acute ischemic syndromes (unstable angina, myocardial infarction) than in patients with stable angina. In conclusion, Lp(a) was roughly twice as high in acute (unstable angina, myocardial infarction) than in chronic (stable angina) ischemic syndromes, but there was no difference between chronic stable angina and non-IHD. Serum level determination of Lp(a) made a poor contribution in predicting the extent of coronary artery disease.     

IL-6、IL-27与ST段抬高型心肌梗死患者冠状动脉介入治疗预后的关系

目的探讨白细胞介素6(IL-6)、白细胞介素27(IL-27)与急性ST段抬高型心肌梗死(STEMI)患者冠状动脉介入治疗预后的关系。方法纳入2015年1月至2016年12月在新疆维吾尔自治区人民医院接受冠状动脉介入治疗的初发STEMI患者,收集其临床资料及介入治疗前血液标本,采用酶联免疫吸附法检测血浆IL-6和IL-27水平。根据患者术后一年是否发生主要不良心血管事件(MACE)将其分为对照组和MACE组,利用多因素Logistic回归模型和受试者工作特征(ROC)曲线分析IL-6、IL-27与MACE发生的关系及其预测价值。结果 287例初发STEMI患者,男性179例(62.4%),年龄为61.37±9.83岁,其中57例发生MACE(19.9%)。MACE组患者年龄、Gensini评分、血浆IL-6和IL-27水平以及吸烟、糖尿病、双支/多支血管病变比例均显著高于对照组患者。Logistic回归分析显示,IL-6(OR=1.72,95%CI为1.50～2.15,P0.001)和IL-27(OR=1.24,95%CI为1.11～1.42,P=0.001)是STEMI患者介入治疗一年期MACE发生的独立危险因素。IL-6和IL-27预测MACE的曲线下面积分别为0.701和0.690。结论 IL-6和IL-27是STEMI患者冠状动脉介入治疗后一年期MACE发生的独立危险因素,对患者临床结局具有一定的预测价值。     

Percutaneous coronary intervention in unprotected left main coronary artery stenosis: Mid-term outcomes of a single-center observational study

BackgroundPercutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-to–intermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients.MethodsOur study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5–4.1 years).Results661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality.ConclusionULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-to–intermediate SYNTAX score.     

女性冠心病患者冠状动脉介入治疗长期预后

目的:了解女性冠心病患者在接受冠状动脉介入治疗(PCI)后的长期临床疗效.方法:584例经PCI治疗的患者,被分为女性组(122例)和男性组(462例),收集其一般临床资料及PCI治疗情况,并进行长期(3～49个月)临床随访,详细记录患者临床主要不良事件的发生情况.结果:男性患者的全因性死亡率(0:3.03%,P＞0.05)及心因性死亡率(0:2.98%,P＞0.05)有增高趋势,女性患者因心脏病再住院率(15.57%:9.96%,P＜0.05)显著增加,但2组患者其他临床主要不良事件差异无统计学意义.经过校正不匹配因素的偏相关分析显示,男性与心因性死亡(r=0.0874,P＜0.05)及全因性死亡(r=0.0970,P＜0.05)呈正相关.结论:女性患者PCI治疗的长期临床预后良好.     

65岁以上老年患者冠状动脉介入治疗单中心随访研究

目的 观察年龄＞65岁老年患者经皮冠状动脉介入(PCI)的远期疗效.方法 将2003年1月至2005年1月在上海交通大学医学院附属瑞金医院心脏科行PCI治疗并完成随访的1012例患者根据年龄分为＞65岁组(583例)和≤65岁组(429例),记录各组患者的一般资料、临床特征和冠状动脉造影及PCI情况.术后每3个月通过随访记录患者所有原因病死、中风和主要心脏不良事件.比较＞65岁组患者药物洗脱支架和普通金属支架的临床疗效.结果 与年龄≤65岁组比较,年龄＞65岁组患者女性较多、体重较轻、吸烟史少,但高血压病及慢性肾功能不全多见,而且冠状动脉病变程度严重、PCI同期行肾动脉支架术患者增多、完全血运重建率和药物洗脱支架置入比例较低.平均随访17个月,年龄＞65岁组与年龄≤65岁组比较,主要心脏不良事件(12.52%对8.62%,P＜0.05)、所有原因病死率(5.83%对1.17%,P＜0.01)和所有不良事件(15.27%对9.09%,P＜0.01)发生率均增高.年龄＞65岁组患者中,药物洗脱支架组较普通金属支架组主要心脏不良事件发生率显著减少(10.14%对16.51%,P＜0.05),但心源性病死率(3.01%对4.59%,P＞0.05)和所有原因病死率(5.48%对6.42%,P＞0.05)差异无显著性意义.结论 年龄＞65岁老年患者冠状动脉支架术后远期心脏事件和所有原因病死率显著增加;药物洗脱支架可明显降低主要心脏不良事件发生率,但不能减少心源性和非心源性死亡.     

钙化积分与冠状动脉多支病变介入术后预后的相关性

目的 研究冠状动脉钙化积分（CCS）与冠状动脉多支血管病变患者经皮冠状动脉介入治疗（PCI）后近、远期预后的关系.方法 入选145例冠状动脉多支血管病变的冠心病患者,在PCI治疗前均接受了多排螺旋CT （MDCT）检查并计算CCS.根据CCS水平将患者分为三组：CCS≤100、CCS=101～400和CCS＞400组.记录患者PCI操作相关并发症,随访记录患者PCI术后主要不良心血管事件（MACE）情况.结果 CCS＞400组患者Syntax积分[（23.5＆#177;8.8）比（17.9＆#177;8.5）,P＜0.001]、三支血管病变的比率（75.4％比56.3％,P=0.015）和PCI操作相关并发症发生率（21.5％比5.0％,P=0.005）均显著高于CCS≤400组患者.所有患者随访360～2542 d（中位数952 d）,Kaplan-Meier生存分析显示CCS≤100、CCS=101～400和CCS＞400组患者累积无事件生存率差异无统计学意义（84.6％比78.0％比64.6％,P=0.141）.但女性患者中累积无事件生存率差异有统计学意义（100.0％比75.0％比50.0％,Log rank 6.836,P=0.033）.结论 在冠状动脉多支血管病变患者中CCS与PCI预后有关,CCS＞400提示较高的PCI并发症发生率.女性患者CCS越高PCI预后越差.     

经皮冠状动脉介入治疗对冠心病患者髓过氧化物酶水平的影响

目的 探讨经皮冠状动脉介入（PCI）术对冠心病患者外周血髓过氧化物酶（MPO）水平的影响.方法 选取149例冠状动脉造影检查确诊冠心病的患者,按临床类型分为急性心肌梗死组（AMI组,67例）、不稳定心绞痛组（UAP组,42例）、稳定性心绞痛组（SAP组,40例）.各冠心病组根据是否行PCI治疗再分别分为AMI支架组和AMI造影组,UAP支架组和UAP造影组,SAP支架组和SAP造影组.并将15例经冠状动脉造影检查排除冠心病的患者作为非冠心病组（NC组）.用酶联免疫吸附法检测术前和术后30分钟、4小时、12小时、24小时的MPO和高敏C反应蛋白（hs-CRP）水平.结果 （1）术前AMI组的MPO和hs-CRP水平显著高于UAP组、SAP组和NC组（P＜0.01）;UAP组两者均高于SAP组和NC组（P ＜0.05）;SAP组的MPO水平高于NC组（P＜0.01）,两组间的hs-CRP水平比较差异无统计学意义（P＞0.05）.术前MPO水平与hs-CRP水平显著相关（r=0.701,P＜0.01）.（2）各支架组术后30分钟、4小时时的MPO水平均高于术前（P＜0.01）,AMI支架组、UAP支架组、SAP支架组分别于术后4小时、30分钟、30分钟达高峰后很快下降至术前水平.各支架组患者的hs-CRP浓度则逐渐升高,hs-CRP浓度的升高晚于MPO.AMI造影组的MPO和hs-CRP均呈逐渐升高的趋势,而UAP造影组、SAP造影组及NC组MPO、hs-CRP水平造影前后均无明显变化（P＞0.05）.结论 MPO是预测斑块稳定性的敏感指标;介入治疗可致冠心病患者PCI术后早期MPO水平表达增加,即使是斑块处于稳定状态的稳定性心绞痛患者.     

既往胃镜检查对评估经皮冠脉介入术后非急性冠脉综合症患者是否联用质子泵抑制剂的作用

目的 探讨经皮冠脉介入术(PCI)前非急性冠脉综合症(非ACS)患者既往胃镜检查对PCI术后综合评估联用质子泵抑制剂(PPIs)的风险和获益的重要意义.方法 回顾性分析673例行PCI术放置冠脉支架的非ACS患者,先将其分为PPIs联用组和未联用组,然后根据与上消化道不良事件密切相关的危险因素再分高、中、低危亚组,分别比较各组心血管和上消化道不良事件发生率的差别以及既往胃镜检查情况.结果 PCI术前5年内仅12.2％(82/673)的患者曾行胃镜检查,消化性溃疡的总体检出率为32.9％(27/82),PPIs联用组占55.6％(15/27).PPIs联用组患者的心血管不良事件发生率显著高于未联用组(22.6％比8.9％,P＜0.01),其中以消化道高危患者(16.4％,24/146)的心血管不良事件发生率最高(41.7％,10/24),但其上消化道不良事件发生率最低(4.2％,1/24).90.5％ (344/380)的中危患者是年龄≥65岁且联用NSAIDs等药物者,其在PCI术前5年内行胃镜检查的比例显著低于既往有上消化道病史且联用NSAIDs等药物者(PPIs联用组:14.1％比54.5％,P＜0.01;未联用组:7.5％比28.0％,P＜0.01),在PPIs联用组前者心血管不良事件发生率显著高于后者(20.5％比9.1％,P＜0.01),但两者在PCI术后1年内上消化道不良事件的发生率相近(9.0％比9.1％,P ＞0.05).结论 PCI术前既往胃镜检查可提供上消化道基础疾病信息,有助于PCI术后合理应用PPIs,减少心血管不良事件的发生.年龄≥65岁且联用NSAIDs等药物的中危患者是需重点关注的人群.