早发冠心病患者的预后研究

目的研究早发冠心病患者经药物洗脱支架和(或)口服药物治疗后的近中期预后。方法经冠状动脉造影确诊的282例早发冠心病患者(男<55岁,女<65岁)按治疗方式的不同被分为早发冠心病介入治疗组(植入紫杉醇或雷帕霉素洗脱支架+药物治疗)177例和早发冠心病药物治疗组(单纯药物治疗)105例,分别对两组患者进行临床资料的收集比较和为期半年及一年的随访(包括主要心血管不良事件和冠心病的二级预防用药等)研究。结果早发冠心病介入治疗组的男性比例、以急性冠状动脉综合征方式起病的比例、多支病变比例、肌钙蛋白水平、住院天数及阿司匹林和氯吡格雷服用率均高于早发冠心病药物治疗组(P<0.05);与早发冠心病药物治疗组相比,早发冠心病介入治疗组的二级预防(包括二级预防用药的依从性及危险因素的控制)较好,但早发冠心病介入治疗组仍有较高的再发心绞痛和复合心血管不良事件的发生率(P<0.05)。Logistic回归分析显示,肥胖、急性冠状动脉综合征、减低的左心室射血分数可以预测早发冠心病患者在随访一年期间的复合心血管不良事件的发生。结论行药物洗脱支架植入联合药物治疗的早发冠心病患者须强化冠心病的二级预防。

Clinical follow-up of patients with premature coronary artery disease

Objective To evaluate the clinical characteristics and one-year prognosis among patients with premature coronary artery disease (PCAD) implanted with drug-eluting stents.Methods 282 patients with documented PCAD,among which 177(PCI+OMT group)were implanted with drug-eluting stents(paclitaxel-eluting stent or sirolimus-eluting stent)and 105(OMT group)prescribed medicine therapy alone were enrolled and analyzed.All patients were prescribed optimal medicine therapy.Major adverse cardiovascular events(MACEs),including stroke,recurrent angina,recurrent myocardial infarction and cardiac death,and the use of medications for secondary prevention(aspirin,β-blocker,angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,and statins)were collected and analyzed.Results Compared with those receiving optimal medicine therapy alone,patients implanted with drug-eluting stents had higher ratio of male,acute coronary syndromes,multi-vessel disease,higher values of cardiac troponin I,longer length of hospital stay,and higher usage of aspirin and clopidogrel(all P<0.05);though these patients had higher usage of aspirin and clopidogrel in hospital and during follow-up and higher usage of β-blockers and statins during follow-up,they had higher ratio of recurrent anginal and composite MACEs during one-year follow up(all P<0.05).Logistic regression analysis showed that obesity,acute coronary syndrome,and reduced left ventricular ejection fraction predict MACEs in one-year follow up among patients with PCAD.Conclusions Further enhanced strategies should be made for secondary prevention in these PCAD patients implanted with drug-eluting stents and prescribed optimal medicine therapy.