Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Circ Cardiovasc Interv. 2009 Aug;2(4):317-22. doi: 10.1161/CIRCINTERVENTIONS.108.847459.108.847459. Epub 2009 Jul 22.
The presence of atherosclerosis in extracardiac vascular beds is associated with an increased risk of adverse cardiovascular outcomes among stable patients with coronary artery disease (CAD). However, there is little data regarding the impact of the presence and extent of vascular disease on outcomes in patients with CAD undergoing percutaneous coronary intervention.
We analyzed 69,045 consecutive patients from the New York State Coronary Angioplasty Reporting System database who underwent percutaneous coronary intervention between 1998 and 1999. Vascular disease burden was assessed by history of aortoiliac, femoral-popliteal, and carotid disease. Patients were stratified into 3 groups: CAD alone, CAD and 1 additional site, and CAD and 2 or 3 additional sites. A logistic regression model was constructed to determine the relation between vascular disease burden and in-hospital mortality. Any history of vascular disease was present in 5915 (8.6%) of the population, of whom 4840 (82%) had CAD and 1 other disease location and 1075 (18%) had CAD and 2 or 3 other disease locations. There was a significant relationship between the number of disease locations and hospital mortality, ranging from 0.7% in patients with CAD alone to 2.0% and 2.6% for patients with 1 or >or =2 disease locations, respectively (P<0.001). In unadjusted analysis, in-hospital mortality was approximately 3-fold higher (odds ratio, 2.89; 95% CI, 2.31 to 3.60; P<0.001) and 4-fold higher (odds ratio, 3.78; 95% CI, 2.57 to 5.56; P<0.001) for inpatients with CAD and additional vascular disease at 1 site and > or =2 sites, respectively. After multivariable adjustment, each additional vascular bed affected was associated with a 50% increase in in-hospital mortality (odds ratio, 1.50; 95% CI, 1.27 to 1.78; P<0.001).
Among patients with CAD undergoing percutaneous coronary intervention, vascular disease burden is associated with higher rates of adverse events and is an independent predictor of in-hospital mortality.
在患有稳定性冠状动脉疾病（CAD）的患者中，在外周血管床存在动脉粥样硬化与不良心血管结局风险增加相关。然而，关于血管疾病的存在和程度对接受经皮冠状动脉介入治疗的 CAD 患者的预后的影响的数据很少。
我们分析了 1998 年至 1999 年期间在纽约州冠状动脉血管成形术报告系统数据库中接受经皮冠状动脉介入治疗的 69045 例连续患者。通过主动脉髂、股腘和颈动脉疾病的病史评估血管疾病负担。患者分为 3 组：单纯 CAD、CAD 加 1 个额外部位和 CAD 加 2 或 3 个额外部位。构建了逻辑回归模型以确定血管疾病负担与住院死亡率之间的关系。在人群中，有 5915 例（8.6%）存在任何血管疾病史，其中 4840 例（82%）患有 CAD 和 1 个其他部位疾病，1075 例（18%）患有 CAD 和 2 或 3 个其他部位疾病。疾病部位数量与住院死亡率之间存在显著关系，从单纯 CAD 患者的 0.7%到分别有 1 个或 >或=2 个部位疾病的患者的 2.0%和 2.6%（P<0.001）。在未调整分析中，住院死亡率约高 3 倍（优势比，2.89；95%CI，2.31 至 3.60；P<0.001）和 4 倍（优势比，3.78；95%CI，2.57 至 5.56；P<0.001）分别为有 1 个部位和 >或=2 个部位的 CAD 和其他血管疾病的住院患者。在多变量调整后，每个额外的血管床都与住院死亡率增加 50%相关（优势比，1.50；95%CI，1.27 至 1.78；P<0.001）。
在接受经皮冠状动脉介入治疗的 CAD 患者中，血管疾病负担与更高的不良事件发生率相关，是住院死亡率的独立预测因素。
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