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目的探讨既往经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)对再发急性冠脉综合征(Acute Coronary Syndrome,ACS)患者行再次介入治疗的有效性、安全性和对远期预后影响。方法连续纳入2013年1月至12月在阜外医院进行PCI治疗的ACS患者,分为既往PCI和非既往PCI两组,并进行倾向性评分匹配,并进行2年随访,记录死亡、心原性死亡、心肌梗死、再次血运重建、再发卒中、主要心脑血管不良事件(包括死亡、心肌梗死、再次血运重建及再发卒中)及支架内血栓的发生情况,对比两组的远期预后差别。结果共纳入6194例行PCI的ACS患者。既往PCI组共1256例,既往非PCI组共4938例。既往PCI组患者年龄更高,合并冠心病危险因素更多。2年随访结果显示,既往PCI组全因死亡率(2.3%vs.1.1%,p=0.001)、心原性死亡(1.7%vs.0.5%,p<0.001)、急性心肌梗死(2.7%vs.1.8%,p=0.040)及主要心脑血管不良事件(13.9%vs.11.8%,p=0.039)显著高于既往非PCI组,而血运重建、脑卒中及支架内血栓发生率没有显著差别。多因素COX回归分析发现:既往PCI、年龄、左室射血分数<40%及介入治疗不成功是全因死亡和心原性死亡的独立危险因素(p<0.05)。经过倾向性评分匹配后,两组在年龄、左室射血分数、介入治疗不成功等方面均无显著差异。多因素COX回归显示:年龄、左室射血分数低于40%及糖尿病史是全因死亡的独立危险因素(p<0.05),同时年龄、左室射血分数低于40%及介入治疗不成功是心原性死亡的独立危险因素(p<0.05),而既往PCI不再是全因死亡(HR=1.81,95%CI:0.99–3.28,p=0.051)和心原性死亡(HR=1.09,95%CI:1.04–1.14,p=0.062)的独立危险因素。结论在中国单中心大样本人群,对于有相同危险因素的患者,既往PCI不是再发ACS介入治疗远期预后不良的独立危险因素。
Objective To investigate the efficacy, safety and long-term prognosis of percutaneous coronary intervention (PCI) in patients with recurrent acute coronary syndrome (ACS). Methods Patients with ACS who underwent PCI in Fu Wai Hospital from January to December 2013 were enrolled in this study. The patients were divided into two groups: previous PCI and non-PCI. Tendency score matching and follow-up were conducted for 2 years. The death, The incidence of sexual death, myocardial infarction, revascularization, recurrent stroke and major cardiovascular and cerebrovascular adverse events (including death, myocardial infarction, revascularization and recurrent stroke) and stent thrombosis were compared between the two groups Prognosis difference. Results A total of 6194 ACS patients were included. A total of 1256 cases of previous PCI group, a total of 4938 non-PCI group. Patients in the previous PCI group were older and had more risk factors for coronary heart disease. At 2-year follow-up, all-cause mortality (2.3% vs 1.1%, p = 0.001), cardiomyogenic death (1.7% vs.0.5%, p <0.001), acute myocardial infarction .1.8%, p = 0.040) and major cardio-cerebral vascular events (13.9% vs.11.8%, p = 0.039) were significantly higher than those in the non-PCI group. However, the incidences of revascularization, stroke and stent thrombosis were not significantly different difference. Multivariate Cox regression analysis found that previous PCI, age, LV ejection fraction <40%, and unsuccessful intervention were independent risk factors for all-cause and cardiac death (p <0.05). After the propensity score matched, there was no significant difference between the two groups in terms of age, left ventricular ejection fraction, unsuccessful interventional therapy and so on. Multivariate Cox regression showed that age, LV ejection fraction below 40%, and diabetes mellitus were independent risk factors for all-cause mortality (p <0.05), while age, LV ejection fraction below 40%, and intervention therapy Success was an independent risk factor for cardiogenic death (p <0.05), whereas previous PCI was no longer all-cause death (HR = 1.81,95% CI: 0.99-3.28, p = 1.09, 95% CI: 1.04-1.14, p = 0.062). Conclusions In a large single-center Chinese population, independent PCI was not an independent risk factor for long-term adverse prognosis in patients with similar risk factors.