经桡动脉介入治疗冠心病的住院期间疗效和主要不良心脏事件的预测因素
경뇨동맥개입치료관심병적주원기간료효화주요불양심장사건적예측인소
The in-hospital outcome and predictors of major adverse cardiac events after transradial intervention in patients with coronary artery disease
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2011年 3期 208-211 ,共4页

    刘圣文%乔树宾%徐波%秦学文%姚民%袁晋青%陈珏%刘海波%尤士杰%胡奉环%吴元%戴军%张沛%杨伟宪%窦克非%邱洪%高展%慕朝伟%马卫华%吴永健%李建军%杨跃进%陈纪林%高润霖

    류골문%교수빈%서파%진학문%요민%원진청%진각%류해파%우사걸%호봉배%오원%대군%장패%양위헌%두극비%구홍%고전%모조위%마위화%오영건%리건군%양약진%진기림%고윤림

    血管成形术,经腔,经皮冠状动脉%桡动脉%冠状动脉疾病 血管成形術,經腔,經皮冠狀動脈%橈動脈%冠狀動脈疾病
    혈관성형술,경강,경피관상동맥%뇨동맥%관상동맥질병
    Angioplasty,transluminal,percutaneous coronary%Radial artery%Coronary disease
    目的 评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素.方法 入选阜外心血管病医院2004年5月至2009年5月16 281例经桡动脉介入治疗冠心病患者(桡动脉组)和5388例经股动脉介入治疗冠心病患者(股动脉组).比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效,并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件(包括死亡、心肌梗死和靶病变血运重建)的预测因素.结果 与股动脉组比较,桡动脉组冠状动脉导管插入时间较长(P＜0.01),X线曝光时间、对比剂用量差异无统计学意义.桡动脉组与股动脉组操作成功率差异无统计学意义(95.5%比96.2%,P＞0.05).血管径路并发症比例桡动脉组低于股动脉组(0.1%比1.3%,P＜0.01).桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组(分别为1.6%比3.8%,P＜0.01;0.2%比0.4%,P＜0.01).多因素logistic回归分析表明,经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁(OR:1.98,95%可信区间:1.50～2.61,P＜0.01)、既往心肌梗死(OR:2.14,95%可信区间:1.63～2.82,P＜0.01)、置入药物洗脱支架(OR:0.68,95%可信区间:0.47～0.98,P=0.04)、冠状动脉夹层(OR:4.08,95%可信区间:2.28～7.33,P＜0.01)、左主干病变(OR:2.12,95%可信区间:1.09～4.13,P=0.03)、支架数(OR:1.25,95%可信区间:1.09～1.43,P＜0.01)、支架总长度(OR:1.01,95%可信区间:1.00～1.02,P=0.03).结论 经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性.年龄≥65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素.
    목적 평개경뇨동맥개입치료관심병적주원기간안전성화유효성급주요불양심장사건적예측인소.방법 입선부외심혈관병의원2004년5월지2009년5월16 281례경뇨동맥개입치료관심병환자(뇨동맥조)화5388례경고동맥개입치료관심병환자(고동맥조).비교뇨동맥조여고동맥조환자림상특정、조작특점급주원기간림상료효,병분석경뇨동맥개입치료환자주원기간발생주요불양심장사건(포괄사망、심기경사화파병변혈운중건)적예측인소.결과 여고동맥조비교,뇨동맥조관상동맥도관삽입시간교장(P＜0.01),X선폭광시간、대비제용량차이무통계학의의.뇨동맥조여고동맥조조작성공솔차이무통계학의의(95.5%비96.2%,P＞0.05).혈관경로병발증비례뇨동맥조저우고동맥조(0.1%비1.3%,P＜0.01).뇨동맥조주원기간주요불양심장사건발생솔、사망발생솔균저우고동맥조(분별위1.6%비3.8%,P＜0.01;0.2%비0.4%,P＜0.01).다인소logistic회귀분석표명,경뇨동맥개입치료환자주원기간발생주요불양심장사건적독립예측인소위년령≥65세(OR:1.98,95%가신구간:1.50～2.61,P＜0.01)、기왕심기경사(OR:2.14,95%가신구간:1.63～2.82,P＜0.01)、치입약물세탈지가(OR:0.68,95%가신구간:0.47～0.98,P=0.04)、관상동맥협층(OR:4.08,95%가신구간:2.28～7.33,P＜0.01)、좌주간병변(OR:2.12,95%가신구간:1.09～4.13,P=0.03)、지가수(OR:1.25,95%가신구간:1.09～1.43,P＜0.01)、지가총장도(OR:1.01,95%가신구간:1.00～1.02,P=0.03).결론 경뇨동맥개입치료관심병재주원기간구유량호적유효성화안전성.년령≥65세、기왕심기경사、치입약물세탈지가、관상동맥협층、좌주간병변、지가수、지가총장도시경뇨동맥개입치료주원기간발생주요불양심장사건적독립예측인소.
    Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of chinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events ( composite of death, myocardial infarction,or target lesion revascularization) of TRI. Results The annulations time was significantly longer for TRIthan TFI (P ＜0. 01 ), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96. 2% for TFI) were similar between the two groups. However, the rates of vascular complications (0. 1% for TRI group and 1.3% for TFI group, P ＜0. 01 ), incidence of in-hospital major adverse cardiac events (1.6% vs. 3. 8%, P＜ 0.01) and in-hospital death (0.2% vs. 0.4%, P＜0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥65 ( OR: 1.98,95% CI: 1. 50 - 2. 61, P ＜ 0. 01 ), prior myocardial infarction ( OR:2. 14, 95% CI: 1.63 - 2. 82, P ＜0. 01 ), use of drug-eluting stent (DES) ( OR:0. 68, 95% CI:0. 47 - 0. 98, P = 0. 04 ), dissection during procedure (OR:4.08, 95%CI:2.28-7.33, P＜0.01), left main lesion (OR:2. 12, 95% CI:1.09-4. 13, P=0.03), number of implanted stents (OR:1.25, 95% CI:1.09 - 1.43, P ＜0.01), and total stented length (OR:1.01, 95% CI:1. 00 -1. 02 , P=0.03). Conclusions In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.
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