[慢性阻塞性肺疾病对急性冠状动脉综合征患者经皮冠状动脉介入治疗医院结局的影响]

[Influence of chronic obstructive pulmonary disease on hospital outcomes of percutaneous coronary interventions in patients with acute coronary syndrome].

作者信息

Frolov A A, Fedotov V D, Frolov I A, Pochinka I G, Protasova N V, Kouzova G N, Mukhin A S, Kuzmichev K V

机构信息

Privolzhsky Research Medical University.

City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District.

出版信息

Ter Arkh. 2024 Apr 16;96(3):253-259. doi: 10.26442/00403660.2024.03.202638.

DOI:10.26442/00403660.2024.03.202638

PMID:38713040

Abstract

AIM

To evaluate the impact of chronic obstructive pulmonary disease (COPD) on hospital outcomes of percutaneous coronary interventions (PCI) in patients with acute coronary syndrome (ACS).

MATERIALS AND METHODS

A cohort prospective study of the COPD effect on mortality and coronary microvascular obstruction (CMVO, no-reflow) development after PCI in ACS was carried out. 626 patients admitted in 2019-2020 were included, 418 (67%) - men, 208 (33%) - women. Median age - 63 [56; 70] years. Myocardial infarction with elevation identified in 308 patients (49%), CMVO - in 59 (9%) patients (criteria: blood flow <3 grade according to TIMI flow grade; perfusion <2 points according to Myocardial blush grade; segment resolution <70%). 13 (2.1%) patients died. Based on the questionnaire "Chronic Airways Diseases, A Guide for Primary Care Physicians, 2005", 2 groups of patients were identified: 197 (31%) with COPD (≥17 points) and 429 (69%) without COPD (<17 points). Groups were compared on unbalanced data (÷ Pearson, Fisher exact test). The propensity score was calculated, and a two-way logistic regression analysis was performed. The data were balanced by the Kernel "weighting" method, logistic regression analysis was carried out using "weighting" coefficients. Results as odds ratio (OR) and 95% confidence interval.

RESULTS

The conducted research allowed us to obtain the following results, depending on the type of analysis: 1) analysis of unbalanced data in patients with COPD: OR death 3.60 (1.16-11.12); =0.03; OR CMVO 0.65 (0.35-1.22); =0,18; 2) two-way analysis with propensity score: OR death 3.86 (1.09-13.74); =0.04; OR CMVO 0.61 (0.31-1.19); =0.15; 3) regression analysis with "weight" coefficients: OR death 12.49 (2.27-68.84); =0.004; OR CMVO 0.63 (0.30-1.33); =0.22.

CONCLUSION

The presence of COPD in patients with ACS undergoing PCI increases mortality and does not affect the incidence of CMVO.

摘要

目的

评估慢性阻塞性肺疾病（COPD）对急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后医院结局的影响。

材料与方法

开展一项关于COPD对ACS患者PCI后死亡率和冠状动脉微血管阻塞（CMVO，无复流）发生影响的队列前瞻性研究。纳入2019年至2020年收治的626例患者，其中418例（67%）为男性，208例（33%）为女性。中位年龄为63[56；70]岁。308例患者（49%）确诊为ST段抬高型心肌梗死，59例（9%）患者发生CMVO（标准：根据心肌梗死溶栓试验（TIMI）血流分级，血流<3级；根据心肌灌注分级，灌注<2分；节段分辨率<70%）。13例（2.1%）患者死亡。根据《慢性气道疾病，初级保健医生指南，2005》调查问卷，将患者分为两组：197例（31%）患有COPD（≥17分），429例（69%）未患COPD（<17分）。对不平衡数据组进行比较（÷Pearson检验、Fisher精确检验）。计算倾向得分，并进行双向逻辑回归分析。采用核“加权”方法平衡数据，使用“加权”系数进行逻辑回归分析。结果以比值比（OR）和95%置信区间表示。

结果

根据分析类型，本研究得出以下结果：1）COPD患者不平衡数据分析：OR死亡3.60（1.16 - 11.12）；P = 0.03；OR CMVO 0.65（0.35 - 1.22）；P = 0.18；2）倾向得分双向分析：OR死亡3.86（1.09 - 13.74）；P = 0.04；OR CMVO 0.61（0.31 - 1.19）；P = 0.15；3）“加权”系数回归分析：OR死亡12.49（2.27 - 68.84）；P = 0.004；OR CMVO 0.63（0.30 - 1.33）；P = 0.22。