有缺血性卒中史的冠心病患者经皮冠状动脉介入治疗的长期疗效

目的 探讨接受经皮冠状动脉介入治疗(PCI)且既往有缺血性卒中史的冠心病患者的临床特点和长期随访的结果.方法 回顾性分析北京协和医院2003年1月至2007年12月连续行PCI的2053例患者的临床资料,并随访至2009年12月.随访终点事件包括全因死亡、心原性死亡、支架内血栓形成、靶病变再次血管重建、再次心肌梗死、脑梗死.统计随访期间患者主要出血事件的发生率.结果 共随访1945例冠心病患者,其中222例患者既往有缺血性卒中病史.与非缺血性卒中患者比较,有缺血性卒中史患者的年龄较大(P =0.000),高血压患病率(P=0.000)、糖尿病患病率(P =0.005)和多支病变(P=0.000)比例较高.患者随访时间为(35.0±19.6)个月.与非缺血性卒中患者比较,有缺血性卒中史患者的心原性死亡(8.5％比3.9％,P =0.002)、再次脑梗死(5.8％比1.4％,P =0.000)的发生率较高,服用双联抗血小板时间差异无统计学意义(13.77±11.33)个月比(13.94±11.33)个月,P=0.986],主要出血事件的发生率差异无统计学意义(5.8％比3.6％,P=0.100),而脑出血的发生率较高(1.8％比0.5％,P=0.028).结论 与非缺血性卒中患者比较,既往有缺血性卒中史的冠心病患者有更高的危险因素患病率,冠状动脉受累的部位更多,随访期间心原性死亡和再次脑梗死的发生率更高,在不减少双联抗血小板治疗时间的情况下脑出血的发生率更高.

Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke

Objective To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention(PCI) with prior ischemic stroke.Methods A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009.End-point included all-cause mortality,cardiac death,stent thrombosis,target-lesion revascularization,myocardial infarction,re-cerebral infarction.Major bleeding events were recorded during follow-up.Results There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke.Compared patients without prior ischemic stroke,patients with prior ischemic stroke were older ( P = 0.000),had higher hypertension morbidity(P = 0.000 ),higher diabetes mellitus morbidity ( P = 0.005 ),higher incidence of multi-vessels disease( P = 0.000).During the follow-up of (35.0 ± 19.6) months,cardiac death rate( 8.5％ vs.3.9％,P=0.002)and re-cerebral infarction rate (5.8％ vs.1.4％,P=0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke.Dual antiplatelet therapy treatment time ( 13.77 ±11.33 ) months vs.( 13.94 ± 11.33 ) months,P = 0.986 ] and major bleeding events (5.8％ vs.3.6％,P =0.l00)were similar between the two groups and cerebral hemorrhage rate( 1.8％ vs.0.5％,P =0.028)were higher in patients with prior ischemic stroke than patients without prior ischemic stroke.Conclusion Patients with prior ischemic stroke were associated with increased rate of risk factors,multiple coronary artery disease,cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.