| 对比两种完全血运重建对冠状动脉多支血管病变伴慢性肾脏疾病患者临床预后的影响 |
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| 引用本文： | 王志坚,周玉杰,刘宇扬,史冬梅,赵迎新,郭永和,成万钧,杨清. 对比两种完全血运重建对冠状动脉多支血管病变伴慢性肾脏疾病患者临床预后的影响[J]. 中国循环杂志, 2011, 26(5). DOI: 10.3969/j.issn.1000-3614.2011.05.006 |
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| 作者姓名： | 王志坚 周玉杰 刘宇扬 史冬梅 赵迎新 郭永和 成万钧 杨清 |
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| 作者单位： | 首都医科大学附属北京安贞医院,十二病房,北京市,100029 |
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| 摘 要： | 目的:对比药物洗脱支架(DES)和冠状动脉旁路移植术(CABG)两种完全血运重建方式对冠状动脉多支病变伴慢性肾脏疾病(CKD)患者临床预后的影响.方法:根据改良MDRD公式,对因冠状动脉多支病变接受DES和CABG的患者的肾功能进行评估,筛选出824例CKD患者接受了完全血运重建治疗,其中冠状动脉双支病变409例(DES 312例,CABG 97例),冠状动脉三支病变415例(DES 167例,CABG 248例).为校正基线资料的差异,对冠状动脉双支病变和三支病变置入DES和接受了CABG的临床预后进行分别对比.首要终点为2年内全因死亡、心肌梗死以及脑血管事件的复合终点事件,次级终点为2年内再次血运重建.结果:在冠状动脉双支病变患者中,DES患者复合终点事件及再次血运重建的发生率均与CABG患者相近,差异无统计学意义(P>0.05).在三支病变患者中,DES患者复合终点的发生率与CABG患者相近,差异无统计学意义(P>0.05).而DES患者再次血运重建的发生率显著高于CABG患者,差异有统计学意义(P<0.05).Kaplan-Meier生存曲线分析:在冠状动脉三支病变患者中,DES患者2年内无复合终点事件的生存率与CABG患者相比,差异均无统计学意义(P>0.05);而再次血运重建生存率在DES患者明显低于CABG患者,差异有统计学意义(P<0.05).Cox多因素分析表明,冠状动脉三支病变人群中DES患者再次血运重建的风险显著高于CABG患者(风险比:2.32,95%可信区间:1.57～7.33,P=0.024).结论:在冠状动脉多支病变伴CKD患者中,CABG和DES两种血运重建策略显示出相同的无复合终点生存率.但在冠状动脉三支病变患者中,即使在同样接受完全血运重建治疗后,DES再次血运重建的风险依然高于CABG.
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| 关 键 词： | 慢性肾脏疾病 冠状动脉多支血管病变 药物洗脱支架 冠状动脉旁路移植术 |
Prognosis Impact of Two Complete Revascularization in Patients of Multi Coronary Vessel Disease Combined With Chronic Kidney Disease |
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| WANG Zhi-jian,ZHOU Yu-jie,LIU Yu-yang,SHI Dong-mei,ZHAO Ying-xin,GUO Yong-he,CHENG Wan-jun,YANG Qing. Prognosis Impact of Two Complete Revascularization in Patients of Multi Coronary Vessel Disease Combined With Chronic Kidney Disease[J]. Chinese Circulation Journal, 2011, 26(5). DOI: 10.3969/j.issn.1000-3614.2011.05.006 |
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| Authors: | WANG Zhi-jian ZHOU Yu-jie LIU Yu-yang SHI Dong-mei ZHAO Ying-xin GUO Yong-he CHENG Wan-jun YANG Qing |
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| Affiliation: | WANG Zhi-jian,ZHOU Yu-jie,LIU Yu-yang,SHI Dong-mei,ZHAO Ying-xin,GUO Yong-he,CHENG Wan-jun,YANG Qing. Department of Cardiology,Beijing Anzhen Hospital,Capital University of Medical Science,Beijing(100029),China |
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| Abstract: | Objective:To compare the clinical prognosis between two complete revascularization methods of drug eluting stent(DES)implantation and coronary artery bypass grafting(CABG)in patients with multi coronary vessel disease combined with chronic kidney disease(CKD). Methods:We selected 824 patients with 2-or 3-vessel coronary lesions who received DES or CABG,and evaluated their renal function by modified MDRD equation.There were 409 patients had 2-vessel disease(312 of them were treated with DES and 97 with CABG)... |
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| Keywords: | Chronic kidney disease Multi coronary vessel disease Drug eluting stent Coronary artery bypass grafting |
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