无需二次血运重建患者复发性心绞痛的预测因素
Predictors of recurrent angina in patients with no need for secondary revascularization.
作者信息
Xu Tian, Li Ya, Zhao Li-Ding, Fu Guo-Sheng, Zhang Wen-Bin
机构信息
Department of Cardiovascular Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou 310016, China.
出版信息
World J Emerg Med. 2021;12(1):42-47. doi: 10.5847/wjem.j.1920-8642.2021.01.007.
BACKGROUND
Approximately 20% to 30% of patients with coronary artery disease (CAD) develop recurrent angina pectoris following successful and complete coronary revascularization utilizing percutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectoris in patients who have undergone successful coronary revascularization using PCI, but on repeat coronary angiography have no need for secondary revascularization.
METHODS
The study comprised 3,837 patients with CAD, who were enrolled from January 2007 to June 2019. They had undergone successful PCI; some of them redeveloped angina pectoris within one year after the procedure, but on repeat coronary angiography had no need for revascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluate the velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was used to investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent angina according to the TIMI frame count were assessed using multivariate linear regression.
RESULTS
In this retrospective study, 53.5% of patients experienced recurrent angina pectoris. By multivariate logistic regression, the following characteristics were statistically identified as risk factors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoprotein cholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count ( for all <0.05). Similarly, using multivariate linear regression, the statistical risk factors for TIMI frame count included: female sex, older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dual antiplatelet therapy.
CONCLUSIONS
Patient characteristics of female sex, older age, diabetes, and elevated BMI are associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrent angina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L are risk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy is negatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.
背景
约20%至30%的冠心病（CAD）患者在经皮冠状动脉介入治疗（PCI）成功实现完全冠状动脉血运重建后会出现复发性心绞痛。我们旨在研究在PCI成功实现冠状动脉血运重建但再次冠状动脉造影显示无需二次血运重建的患者中，复发性心绞痛的预测因素。
方法
该研究纳入了2007年1月至2019年6月期间的3837例CAD患者。他们均接受了成功的PCI治疗；其中一些患者在术后一年内再次出现心绞痛，但再次冠状动脉造影显示无需血运重建。心肌梗死溶栓（TIMI）帧数用于评估随访血管造影中冠状动脉血流速度。采用多因素逻辑回归分析来研究复发性心绞痛的危险因素。同样，使用多因素线性回归分析评估根据TIMI帧数预测复发性心绞痛的因素。
结果
在这项回顾性研究中，53.5%的患者出现复发性心绞痛。通过多因素逻辑回归分析，以下特征在统计学上被确定为复发性心绞痛的危险因素：女性、年龄较大、当前吸烟、低密度脂蛋白胆固醇（LDL-C）≥1.8 mmol/L以及TIMI帧数升高（所有P均<0.05）。同样，使用多因素线性回归分析，TIMI帧数的统计学危险因素包括：女性、年龄较大、糖尿病、体重指数（BMI）、术后未采用双联抗血小板治疗。
结论
女性、年龄较大、糖尿病和BMI升高这些患者特征与TIMI帧数增加、冠状动脉微循环功能障碍以及初次PCI成功后复发性心绞痛有关。此外，当前吸烟和LDL-C≥1.8 mmol/L是复发性心绞痛的危险因素。相比之下，双联抗血小板治疗与较高的TIMI帧数和复发性心绞痛风险呈负相关。
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