【摘要】：目的:通過對(duì)單中心大樣本經(jīng)皮冠狀動(dòng)脈(冠脈)介入治療(PCI)患者2年隨訪結(jié)果的分析,探討經(jīng)股動(dòng)脈路徑患者的臨床特點(diǎn),比較股動(dòng)脈路徑、橈動(dòng)脈路徑的安全性和對(duì)預(yù)后的影響。方法:在2013年阜外醫(yī)院10 557例經(jīng)股動(dòng)脈路徑和橈動(dòng)脈路徑穿刺的PCI患者中,比較橈動(dòng)脈路徑組(n=9 745)和股動(dòng)脈路徑組(n=812)患者的臨床特點(diǎn),分析不同動(dòng)脈路徑對(duì)預(yù)后的影響。結(jié)果:經(jīng)橈動(dòng)脈路徑患者9 745例(90.9%);經(jīng)股動(dòng)脈路徑患者812例(7.6%),股動(dòng)脈路徑組患者中,高齡、女性、糖尿病、陳舊性心肌梗死、PCI史、冠脈旁路移植術(shù)(CABG)史患者比例更高,差異均有統(tǒng)計(jì)學(xué)意義(P0.001);股動(dòng)脈路徑組患者冠脈左主干病變、左主干或三支病變更多見,差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。Logistic回歸分析:女性、年齡、陳舊性心肌梗死、PCI史、CABG史,左主干病變均是選擇股動(dòng)脈路徑的預(yù)測(cè)因素。傾向性評(píng)分匹配后,股動(dòng)脈路徑組住院期間死亡率較橈動(dòng)脈路徑組高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2年隨訪Kaplan-Meier生存分析所有終點(diǎn)事件均沒有顯著性差異。Cox多因素回歸分析發(fā)現(xiàn),股動(dòng)脈路徑是出血學(xué)術(shù)研究聯(lián)合會(huì)(BARC)分級(jí)2型以上出血的獨(dú)立危險(xiǎn)因素(HR=2.210,P=0.013),不是主要心臟終點(diǎn)事件的獨(dú)立危險(xiǎn)因素。結(jié)論:(1)女性,高齡,陳舊性心肌梗死,PCI史,CABG史,左主干病變均是股動(dòng)脈路徑的預(yù)測(cè)因素;(2)經(jīng)股動(dòng)脈路徑患者住院期間死亡率較橈動(dòng)脈路徑患者高;(3)股動(dòng)脈路徑是BARC分級(jí)2型以上出血的獨(dú)立危險(xiǎn)因素,但對(duì)PCI治療患者的長期預(yù)后無明顯影響。
[Abstract]:Objective: to investigate the clinical characteristics of patients undergoing percutaneous coronary intervention (PCI) by single center and large sample percutaneous coronary intervention (PCI) for 2 years, and to compare the femoral artery pathway. Safety of radial artery pathway and its prognostic implications. Methods: the clinical characteristics of 10 557 patients with PCI through femoral artery pathway and radial artery pathway in Fuwai Hospital in 2013 were compared with those of radial artery pathway group (n = 9,745) and femoral artery pathway group (n = 812). The effects of different arterial pathways on prognosis were analyzed. Results: 9 745 cases (90.9%) were treated by radial artery route. The proportion of elderly, female, diabetic, old myocardial infarction, PCI history and (CABG) history of coronary artery bypass grafting was higher in the femoral artery pathway group than in the femoral artery pathway group (7.6%), and in the femoral artery pathway group, the proportion of elderly, female, diabetic, old myocardial infarction, coronary artery bypass grafting history was higher. The difference was statistically significant (P0.001). The left main coronary artery lesions, left main coronary artery lesions or three vessel lesions were more common in the femoral artery pathway group (P0.001). Logistic regression analysis showed that female, age, old myocardial infarction, PCI history, CABG history, and left main coronary artery lesion were more common in the femoral artery pathway group than those in the left main coronary artery group (P0.001). Left main artery lesions are predictors of the choice of femoral artery pathways. The mortality rate in the femoral artery pathway group was higher than that in the radial artery pathway group after matching the tendency score. The difference was statistically significant (P0.05). There was no significant difference in all end-point events after 2-year follow-up Kaplan-Meier survival analysis. Cox multivariate regression analysis showed that there was no significant difference between the two groups. Femoral artery pathway is an independent risk factor (HR=2.210,P=0.013) for (BARC) grade 2 or more bleeding, not an independent risk factor for major cardiac endpoint events. Conclusion: (1) female, old age, old myocardial infarction, PCI history, CABG history, left main artery disease are all predictors of femoral artery pathway, (2) the mortality of patients with femoral artery pathway during hospitalization is higher than that of radial artery pathway. (3) femoral artery pathway is an independent risk factor for BARC grade 2 or more bleeding, but it has no significant effect on the long-term prognosis of PCI patients.
【作者單位】： 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院國家心血管病中心阜外醫(yī)院心內(nèi)科;
【基金】：“十二五”國家科技支撐計(jì)劃項(xiàng)目(2011BAI11B07) 國家自然科學(xué)基金(81470486)
【分類號(hào)】：R541.4

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