冠心病患者PCI术后5年再入院ISR发生危险因素分析

    Risk factors analysis of ISR in patients with coronary heart disease who were readmitted 5 years after PCI

      摘要
    • 摘要:
      目的 研究冠心病患者接受冠状动脉支架植入术后5年再入院患者发生支架内再狭窄（ISR）的危险因素。
      方法 以2016年1月～2017年12月在火箭军特色医学中心首次接受药物洗脱支架植入术并于术后5年再次在中心接受冠状动脉造影的103例冠心病患者作为研究对象。根据冠状动脉造影结果，将他们分为支架内再狭窄（ISR）组（n=49）和非ISR组（n=54）。采用单因素分析比较两组之间的相关临床数据，并对具有统计学意义的有关因素进行Logistic回归分析。
      结果 ISR组的低密度脂蛋白胆固醇（LDL-C）（P<0.05）、糖化血红蛋白（P<0.05）、D-二聚体水平（P<0.01）高于非ISR组，ISR组冠心病家族史比率、术后吸烟比率高于非ISR组（均P<0.05）。运用ROC曲线分析各因素对PCI术后ISR发生的预测价值，结果提示LDL-C在预测ISR存在时的ROC曲线下面积为0.943（P<0.01），最佳临界值为2.34 mmol /L，灵敏度为85.7%，特异度为94.4%；D-二聚体的ROC曲线下面积为0.778（P<0.01），最佳临界值为0.49μg /L，灵敏度为63.3%，特异度为85.2%；糖化血红蛋白的ROC曲线下面积为0.702（P<0.01），最佳临界值为7.45%，灵敏度为51.0%，特异度为98.1%。冠心病家族史的ROC曲线下面积为0.599（P=0.082），术后吸烟的ROC曲线下面积为0.716（P<0.01）。
      结论 LDL-C、D-二聚体和糖化血红蛋白水平、冠心病家族史和术后吸烟是ISR的独立危险因素。

       

      Abstract:
      AIM To investigate the risk factors for in-stent restenosis (ISR) in coronary heart disease patients who were admitted to hospital 5 years after coronary stent implantation.
      METHODS A total of 103 coronary heart disease patients who received drug-eluting stent implantation for the first time in our hospital from January 2016 to December 2017 and underwent coronary angiography again in our hospital 5 years after the procedure were selected as the study subjects.According to the coronary angiography results, they were divided into an in-stent restenosis (ISR) group (n=49) and a non-ISR group (n=54). Univariate analysis was used to compare the relevant clinical data between the two groups, and logistic regression analysis was performed on the relevant factors with statistically significant differences.
      RESULTS The low-density lipoprotein cholesterol (LDL-C), glycated hemoglobin (P<0.05), and D-dimer levels (P<0.01) in the ISR group were higher than those in the non ISR group. The family history of coronary heart disease and postoperative smoking rate in the ISR group were higher than those in the non ISR group (all P<0.05). The ROC curve was used to analyze the predictive value of various factors on the occurrence of ISR after PCI. The results showed that the area under the ROC curve of LDL-C in predicting the presence of ISR was 0.943 (P<0.01), the optimal critical value was 2.34 mmol/L, the sensitivity was 85.7%, and the specificity was 94.4%; The area under the ROC curve of D-dimer is 0.778 (P<0.01), and the optimal critical value is 0.49 μ G/L, sensitivity of 63.3%, specificity of 85.2%; The area under the ROC curve of glycated hemoglobin is 0.702 (P<0.01), with an optimal critical value of 7.45%, sensitivity of 51.0%, and specificity of 98.1%. The area under the ROC curve of a family history of coronary heart disease was 0.599 (P=0.082), and the area under the ROC curve of postoperative smoking was 0.716 (P<0.01).
      CONCLUSION LDL-C, D-dimer, glycosylated hemoglobin level, family history of coronary heart disease, and smoking cessation after surgery are independent risk factors for ISR.

       

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