冠状动脉病变支架后非罪犯病变快速进展的预测因子

doi:10.3969/j.issn.1006-7795.2013.01.017

摘要/Abstract

摘要：

目的旨在探讨冠状动脉(以下简称冠脉)非罪犯病变快速进展的预测因子。方法连续收集2006年1月至2011年4月于罪犯病变部位成功置入支架共170例冠状动脉粥样硬化性心脏病(以下简称冠心病)患者的临床资料,术后1至12个月期间再次行冠脉造影,观察经皮冠状动脉介入(percutaneous coronary interventions,PCI)术时非罪犯冠脉病变的进展情况,根据这些病变的进展情况将所有患者分为快速进展组(n=49)和缓慢进展组(n=121)。结果在研究人群中,非罪犯病变的快速进展的患者占28%,这些患者应用他汀类药物治疗的比例相对较低,多支血管病变的比例较高。快速进展组的三酰甘油(triglyceride,TG)(2.02 vs 1.59 mmol/L, P=0.020)、总胆固醇(total cholesterol, TC) (4.25 vs 3.79 mmol/L,P=0.013)及TC的降低幅度(-0.80 vs-1.25 mmol/L,P=0.030)和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)(2.42 vs 2.16 mmol/L,P=0.030)及LDL-C的降低幅度(-0.39 vs-0.75 mmol/L, P=0.020)明显高于缓慢进展组。多因素Logistic回归分析显示,多支血管病变、TG浓度、LDL-C降低幅度、支架内再狭窄以及他汀类药物治疗均是非罪犯病变快速进展的独立预测因子。结论多支血管病变、TG浓度、LDL-C降低幅度、支架内再狭窄以及他汀类药物治疗与非罪犯冠脉病变的快速进展存在相关性,这充分证明了冠心病患者成功PCI术后继续强化他汀治疗的必要性。

关键词: 非罪犯冠脉病变, 快速进展, 冠状动脉粥样硬化性心脏病

Abstract:

Objective The majority of cardiovascular events in patients undergoing percutaneous coronary interventions (PCI) arise from the progression of non-culprit coronary lesions (NCL) during the follow-up period. The purpose of this study was to investigate the predictors related to the rapid progression of NCL of patients undergoing PCI. Methods Between Jan. 2006 and Apr 2011, 170 consecutive patients who underwent coronary angiograms again with a time interval from 1 to 12 months after successful stent implantation at culprit-lesion. The patients were divided into rapid progression group (n=49) and slow progression group (n=121) according to definition of rapid progression. Results Twenty-eight percent of patients had rapid progression of non- lesions. Rapid progressors had higher percentage of multivessel diseases and statin therapy. At follow-up, a significant difference was observed between rapid progression group and slow progression group in triglyceride (TG) (2.02 vs 1.59 mmol/L, P=0.020), total cholesterol (TC) (4.25 vs 3.79 mmol/L, P=0.013), and change of TC (-0.80 vs -1.25 mmol/L, P=0.03), low-density lipoprotein cholesterol (LDL-C) (2.42 vs 2.16 mmol/L, P=0.03) and change of LDL-C (-0.39 vs -0.75 mmol/L, P=0.020). Multivariate Logistic regression analysis revealed that multivessel diseases, on-treatment for TG, change of LDL-C, rate of in-stent restenosis and rate of statin therapy were independent predictors for rapid progression. Conclusion Multivessel diseases, on-treatment for TG, change of LDL-C, rate of in-stent restenosis and rate of statin therapy were associated with the rapid progression of non- coronary lesion. This finding highlights the need for intensive statins therapy in patients with coronary artery disease after successful PCI.

Key words: non-culprit coronary lesions, rapid progression, coronary heart disease

中图分类号:

R541.4

陈文明, 李东宝, 陈晖, 李虹伟, 赵捷, 赵慧强, 梁思文, 丁晓松. 冠状动脉病变支架后非罪犯病变快速进展的预测因子[J]. 首都医科大学学报, 2013, 34(1): 90-94.

CHEN Wenming, LI Dongbao, CHEN Hui, LI Hongwei, ZHAO Jie, ZHAO Huiqiang, LIANG Siwen, DING Xiaosong. Predictors for rapid progression of non-culprit coronary lesions after successful stent implantation in culprit lesions[J]. Journal of Capital Medical University, 2013, 34(1): 90-94.

参考文献

[1] Glaser R, Selzer F, Faxon D P, et al.Clinical progression of incidental, asymptomatic lesions discovered during culprit vessel coronary intervention[J]. Circulation, 2005,111(2):143-149.

[2] Park M W, Seung K B, Kim P J, et al. Long-term percutaneous coronary intervention rates and associated independent predictors for progression of on-intervened nonculprit coronary lesions[J]. Am J Cardiol, 2009, 104(5):648-652.

[3] Zouridakis E G, Schwartzman R, Garcia-Moll X, et al. Increased plasma endothelin levels in angina patients with rapid coronary artery disease rogression[J]. Eur Heart J, 2001, 22(17): 1578-1584.

[4] Zouridakis E, Avanzas P, Arroyo-Espliguero R, et al.Markers of inflammation and rapid coronary artery disease progression in patients with stable angina pectoris[J]. Circulation, 2004,110(13): 1747-1753.

[5] Tsiamis E, Toutouzas K, Synetos A, et al.Prognostic clinical and angiographic characteristics for the development of a new significant lesion in remote segments after successful percutaneous coronary intervention[J]. Int J Cardiol, 2010,143(1):29-34.

[6] Moise A, Theroux P, Taeymans Y, et al. Clinical and angiographic factors associated with progression of coronary artery disease[J]. J Am Coll Cardiol, 1984,3(13):659-667.

[7] Kaski J C, Chester M R, Chen L, et al. Rapid angiographic progression of coronary artery disease in patients with angina pectoris.The role of complex stenosis morphology[J]. Circulation, 1995, 92(8):2058-2065.

[8] Stone G W, Maehaza A, Lansky A J, et al. A prospective natural-history study of coronary atherosclerosis[J].N Engl J Med,2011,364(3):226-235.

[9] Davies S W, Marchant B, Lyons J P, et al. Irregular coronary lesion morphology after thrombolysis predicts early clinical instability[J]. J Am Coll Cardiol, 1991,18(13):669-674.

[10] Ballantyne C M, Olsson A G, Cook T J, et al.Influence of low high-density lipoprotein cholesterol and elevated triglyceride on coronary heart disease events and response to simvastatin therapy in 4S[J].Circulation,2001, 104(25):3046-3051(7).

[11] Miller M, Cannon C P, Murphy S A, et al. Impact of triglyceride levels beyond low-density lipoprotein cholesterol after acute coronary syndrome in the PROVE IT-TIMI 22 Trial[J]. J Am Coll Cardiol, 2008,51:724-730.

[12] Hodis H N, MacK W J, Azen S P, et al.Triglyceride-and cholesterol-rich lipoproteins have a differential effect on mild/moderate and severe lesion progression as assessed by quantitative coronary angiography in a controlled trial of Lovastatin[J]. Circulation, 1994, 90(1):42-49.

[13] Yin Z X, Zhou Y J, Liu X L,et al.Clinical predictors for progression of nonintervened nonculprit coronary lesions despite low-density lipoprotein cholesterol less than 1.8 mmol/L after successful stent implantation[J].Coron Artery Dis,2011, 22(1):49-54.

[1]	陈璐, 郭新颖, 刘建, 杜凤和, 郭彩霞. 冠状动脉粥样硬化性心脏病患者可溶性高级糖基化终末产物受体与肾功能的相关性分析[J]. 首都医科大学学报, 2022, 43(2): 167-172.
[2]	夏宁, 聂秀红, 王昊, 樊晓君. 支气管哮喘合并OSA与冠心病发病率的相关性研究[J]. 首都医科大学学报, 2022, 43(1): 138-142.
[3]	刘瑾春, 郑秀花, 李宁, 张瑞霞, 张海柱. 不稳定型心绞痛患者冠状动脉侧支循环形成的预测因素研究[J]. 首都医科大学学报, 2021, 42(4): 642-646.
[4]	谷珊珊, 卢洁, 陈刚. 心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值[J]. 首都医科大学学报, 2021, 42(1): 26-30.
[5]	胡宾, 周玉杰, 贾德安, 秦政, 许晓晗, 杨士伟, 周志明. 冠状动脉斑块旋磨联合药物洗脱支架术对不同年龄段老年钙化治疗效果的对比分析[J]. 首都医科大学学报, 2021, 42(1): 101-104.
[6]	李响, 蒲连美, 阮杨, 李红, 金泽宁. 汉族人群ADIPOR1 rs7539542与冠状动脉粥样硬化性心脏病和2型糖尿病的关联分析[J]. 首都医科大学学报, 2020, 41(6): 935-942.
[7]	许晓晗, 程宇婧, 刘晓丽, 周玉杰. 守护生命的“心”路——周玉杰教授[J]. 首都医科大学学报, 2020, 41(5): 844-848.
[8]	李扬, 董然, 芮宏亮, 刘韬帅, 郑居兵, 徐晓宇, 赵洋, 宋邦荣, 张魁. 合并慢性肾功能不全的冠状动脉粥样硬化性心脏病患者冠状动脉搭桥手术的预后及其影响因素[J]. 首都医科大学学报, 2020, 41(4): 597-602.
[9]	魏嘉洁, 矫杰, 周迎生. 2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特征及其危险因素[J]. 首都医科大学学报, 2020, 41(1): 35-39.
[10]	熊筱伟, 郭彩霞, 徐晓薇, 穆利英, 胡宏宇, 陈威, 陈步星. 血浆氧化三甲胺及其前体物质浓度与冠状动脉粥样硬化性心脏病的关系[J]. 首都医科大学学报, 2020, 41(1): 99-102.
[11]	夏勇, 张建卿, 王少霞, 陈丹, 姬建民. 沙库巴曲缬沙坦联合琥珀酸美托洛尔缓释片治疗冠状动脉粥样硬化性心脏病并慢性心力衰竭的效果观察[J]. 首都医科大学学报, 2020, 41(1): 113-118.
[12]	李靖, 高敬. 二尖瓣环自动追踪技术评价冠状动脉粥样硬化性心脏病病人左心室收缩功能[J]. 首都医科大学学报, 2017, 38(3): 386-390.
[13]	王德昭, 马宁, 胡宏宇, 莫大鹏, 付强, 陈威, 姜桂莹, 缪中荣, 陈步星. 冠状动脉病变与弓上动脉颅内外段病变相关性探讨[J]. 首都医科大学学报, 2016, 37(1): 58-61.
[14]	杨耀国, 陈忠, 唐小斌, 寇镭, 吴章敏, 刘晖, 王盛, 张征, 贾云峰, 何楠. 腹主动脉瘤合并冠心病的临床特点及围术期处理[J]. 首都医科大学学报, 2015, 36(1): 23-27.
[15]	马亚红;冼勋德;杨俊芬;甄亚平;刘国庆;杨金奎. 2型糖尿病HDL2b的变化特点及对预测冠心病风险的意义[J]. 首都医科大学学报, 2011, 32(5): 609-613.