Han Tianwen, Wang Qun, Yang Huanwan, Zhou Shanshan, Wang Jing, Jing Jing, Zhang Tao, Liu Yuqi, Chen Yundai
Chinese PLA General Hospital, Beijing, China.
PeerJ. 2019 Apr 26;7:e6804. doi: 10.7717/peerj.6804. eCollection 2019.
The incidences of premature coronary heart disease present a rising trend worldwide. The possible risk factors that may predict the incidence of repeat percutaneous coronary intervention (PCI) in premature acute coronary syndrome (ACS) remains unclear.
A total of 203 patients ≤45 years with ACS from Chinese PLA General Hospital who have undergone angiography twice were included in this report. Data were collected from medical records of patients during hospitalization. Baseline characteristics which have significant differences in the univariate analysis were enrolled into the multiple logistic regression analysis. According to the odds ratio (OR) of these variables, different values were assigned to build a risk model to predict the possible risk of the premature ACS patients undergoing repeat PCI.
Of the 203 young patients, 88 patients (43.3%) underwent repeat PCI. The intermit time (OR 1.002, (95% CI [1.001-1.002])), diastolic blood pressure of second procedure (OR 0.967, (95% CI [0.938-0.996])), stent diameter (OR 0.352, (95% CI [0.148-0.840])), HbA1C of the first procedure (OR 1.835, (95% CI [1.358-2.479])), and Troponin T of the second procedure (OR 1.24, (95% CI [0.981-1.489])) were significantly associated with the incidence of repeat PCI in patients with premature ACS. An aggregate score between 0 and 6 was calculated based on these cutpoints.
For young patients with premature ACS, risk of undergoing repeat PCI was high. HbA1C was a significant, independent predictor for the incidence of repeat revascularization, and weighed more than traditional lipid profile. The glucose metabolism and disorders in patients with premature ACS should be routinely screened.
全球范围内，早发冠心病的发病率呈上升趋势。可能预测早发急性冠状动脉综合征（ACS）患者再次经皮冠状动脉介入治疗（PCI）发生率的风险因素仍不明确。
本研究纳入了203例年龄≤45岁、来自中国人民解放军总医院且接受过两次血管造影的ACS患者。数据收集自患者住院期间的病历。将单因素分析中有显著差异的基线特征纳入多因素逻辑回归分析。根据这些变量的比值比（OR），赋予不同数值以构建风险模型，预测早发ACS患者接受再次PCI的潜在风险。
在这203例年轻患者中，88例（43.3%）接受了再次PCI。两次手术间隔时间（OR 1.002，95%可信区间[1.001 - 1.002]）、第二次手术时的舒张压（OR 0.967，95%可信区间[0.938 - 0.996]）、支架直径（OR 0.352，95%可信区间[0.148 - 0.840]）、第一次手术时的糖化血红蛋白（HbA1C）（OR 1.835，95%可信区间[1.358 - 2.479]）以及第二次手术时的肌钙蛋白T（OR 1.24，95%可信区间[0.981 - 1.489]）与早发ACS患者再次PCI的发生率显著相关。基于这些切点计算出0至6之间的总分。
对于早发ACS的年轻患者，接受再次PCI的风险较高。HbA1C是再次血运重建发生率的一个重要独立预测因素，且比传统血脂指标更具权重。应常规筛查早发ACS患者的糖代谢及相关紊乱情况。
