Zhang Y, Song L, Song Y, Xu L J, Wang H H, Xu J J, Tang X F, Jiang P, Liu R, Zhao X Y, Gao Z, Gao L J, Chen J, Yang Y J, Gao R L, Qiao S B, Xu B, Yuan J Q
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2019 Jan 24;47(1):34-41. doi: 10.3760/cma.j.issn.0253-3758.2019.01.004.
To investigate the impact of coronary lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. In this prospective observational study, a total of 10 119 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention from January 1 to December 31, 2 103 in our hospital were enrolled. The patients were divided into non/mild calcification group (8 268 cases) and moderate/severe calcification group (1 851 cases) according to the angiographic results. The primary endpoint was one-year major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, and target vessel revascularization. The patients were (58.3±10.3) years old, and there were 2 355 females (23.3%). Compared with non/mild calcification group, patients in the moderate/severe calcification group were older ((60.0±10.6) years vs. (57.9±10.2) years, 0.01), and had higher proportion of female (25.4% (470/1 851) vs. 22.8% (1 885/8 268), 0.02), debates (33.9% (628/1 851) vs. 29.0% (2 399/8 268), 0.01), hypertension (68.0% (1 259/1 851) vs. 63.7% (5 264/8 268), 0.01), coronary artery bypass grafting (4.6% (85/1 851) vs. 3.2% (268/8 268), 0.01), stroke (12.6% (233/1 851) vs. 10.4% (861/8 268), 0.01), and renal dysfunction (6.2% (115/1 851) vs. 3.7% (303/8 268), 0.01). Compared with non/mild calcification group, patients in themoderate/severe calcification group experienced longer procedure time (37 (24, 61) min vs. 27 (17,40) min, 0.01) and stent length was longer (32 (23,48) mm vs. 27 (18,38) mm, 0.01), and percent of rotational atherectomy was higher (2.56%(57/2 229) vs. 0.03% (3/11 930), 0.01). One-year follow-up results showed that MACE (7.5% (139/1 846) vs. 4.9% (402/8 243), 0.01), all-cause death (1.0% (19/1 846) vs. 0.6% (49/8 243), 0.04), myocardial infarction (2.2% (41/1 846) vs. 1.4% (114/8 243), 0.01), and target vessel revascularization (5.0% (92/1 846) vs. 3.2% (266/8 243), 0.01) were all significantly higher in moderate/severe calcification group than in non/mild group. Multivariate Cox regression analysis showed that moderate/severe calcification was an independent predictor of MACE at one-year after the procedure (=1.41, 95 1.16-1.72, 0.01). Moderate/severe calcification in coronary lesion is an independent predictor of long-term poor prognosis in coronary heart disease patients undergoing percutaneous coronary intervention.
探讨冠状动脉病变钙化对冠心病患者经皮冠状动脉介入治疗后长期预后的影响。在这项前瞻性观察性研究中，纳入了我院2013年1月1日至12月31日期间连续接受经皮冠状动脉介入治疗的10119例冠心病患者。根据血管造影结果，将患者分为非/轻度钙化组（8268例）和中度/重度钙化组（1851例）。主要终点为1年主要不良心血管事件（MACE），包括全因死亡、心肌梗死和靶血管血运重建。患者年龄为（58.3±10.3）岁，女性2355例（23.3%）。与非/轻度钙化组相比，中度/重度钙化组患者年龄更大（（60.0±10.6）岁 vs.（57.9±10.2）岁，P=0.01），女性比例更高（25.4%（470/1851） vs. 22.8%（1885/8268），P=0.02），糖尿病（33.9%（628/1851） vs. 29.0%（2399/8268），P=0.01），高血压（68.0%（1259/1851） vs. 63.7%（5264/8268），P=0.01），冠状动脉旁路移植术史（4.6%（85/1851） vs. 3.2%（268/8268），P=0.01），卒中史（12.6%（233/1851） vs. 10.4%（861/8268），P=0.01），肾功能不全（6.2%（115/1851） vs. 3.7%（303/8268），P=0.01）。与非/轻度钙化组相比，中度/重度钙化组患者手术时间更长（37（24，61）min vs. 27（17，40）min，P=0.01），支架长度更长（32（23，48）mm vs. 27（18，38）mm，P=0.01），旋磨术使用率更高（2.56%（57/2229） vs. 0.03%（3/11930），P=0.01）。1年随访结果显示，中度/重度钙化组MACE（7.5%（139/1846） vs. 4.9%（402/8243），P=0.01）、全因死亡（1.0%（19/1846） vs. 0.6%（49/8243），P=0.04）、心肌梗死（2.2%（41/1846） vs. 1.4%（114/8243），P=0.01）和靶血管血运重建（5.0%（92/1846） vs. 3.2%（266/8243），P=0.01）均显著高于非/轻度钙化组。多因素Cox回归分析显示，中度/重度钙化是术后1年MACE的独立预测因素（HR=1.41，95%CI 1.16-1.72，P=0.01）。冠状动脉病变中度/重度钙化是经皮冠状动脉介入治疗冠心病患者长期预后不良的独立预测因素。
