经皮冠状动脉介入治疗且有缺血性卒中史的冠心病患者的临床特点
The clinical characteristics of patients underwent percutaneous coronary intervention with history of ischemic stroke

赵东晖.经皮冠状动脉介入治疗且有缺血性卒中史的冠心病患者的临床特点[J].内科急危重症杂志,2015,21(1):

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英文关键词:Cerebrovascular accident Angioplasty Transluminal Percutaneous coronary Treatment outcome

基金项目:上海市卫生局青年课题（20134y116）

作者	单位	E-mail
赵东晖	首都医科大学附属北京安贞医院上海市奉贤区中心医院基金：上海市卫生局青年课题y	zhaodonghui3486@126.com

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中文摘要:

目的探讨行经皮冠状动脉介入治疗(PCI)且合并有缺血性卒中史的冠心病患者的临床特点。方法回顾性分析我院2006年1月至2010年12月连续行PCI的2121例患者的临床资料,占急性冠脉综合征治疗的82%,并随访至2014年6月。随访终点事件包括支架内再狭窄、支架内血栓形成、靶病变再次血管重建、再次心肌梗死、脑梗死、全因死亡、心源性死亡。记录患者随访期间的主要不良事件,并进行统计各事件发生率。结果共随访冠心病患者1950例,其中合并有缺血性卒中病史的患者234例。对比非缺血性卒中患者,前者的年龄更大(P=0.001),高血压患病率(P=0.002)、糖尿病患病率(P=0.006)和多支病变(P=0.001)比例更高。患者随访时间为(61.0±40.5)个月。对比非缺血性卒中患者,有缺血性卒中史患者的心源性死亡(8.9％VS 4.1％,P =0.003)、再次脑梗死(6.4％VS 2.0％,P =0.004)的发生率较高,使用双联抗血小板聚集药物治疗时间差异无统计学意义[(14.55±10.42)个月比(13.99±10.45)个月,P=0.975],主要出血不良事件的发生率差异无统计学意义(5.6％VS 3.8％,P=0.112),而脑出血的发生率较高(2.1％VS 0.7％,P=0.032)。结论对比非缺血性卒中患者,合并有缺血性卒中史的冠心病患者有更高的危险因素患病率,冠状动脉多支病变率更高,随访期间心源性死亡和脑梗死的发生率更高,在不减少使用双联抗血小板集聚药物治疗时间的情况下脑出血的发生率更高。

英文摘要:

Objective To observe the clinical characteristics of patients underwent percutaneous coronary intervention(PCI) with history ischemic stroke. Methods A total of 2121 patients underwent PCI, which accounted for 82% of the treatment of acute coronary syndrome in our hospital from January 2006 to December 2010 were included in this analysis and patients were followed up to June 2014 End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up. Results 1950 patients with coronary heart disease were followed up and 234 patients with history ischemic stroke. Compared to patients without history ischemic stroke, patients with history ischemic stroke were older ( P = 0. 001), had higher hypertension morbidity(P = 0. 002 ), higher diabetes mellitus morbidity ( P = 0. 006 ), higher incidence of multi-vessels disease( P = 0. 001). During the follow-up of (61.0±40.5) months , cardiac death rate( 8.9％ VS 4.1％,P =0.003)and re-cerebral infarction rate (6.4％VS 2.0％,P=0.004) were higher in patients with history ischemic stroke than patients without history ischemic stroke. Dual antiplatelet therapy treatment time[(14.55±10.42)months vs. (13.99±10.45) months, P = 0. 975] and major bleeding events (5.6％ VS 3.8％,P=0.112)were similar between the two groups and cerebral hemorrhage rate( 2.1％ VS 0.7％,P=0.032)were higher in patients with history ischemic stroke than patients without history ischemic stroke. Conclusion Patients with history ischemic stroke are associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.