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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
盖兢泾,韩志奇,金琴花,盖鲁粤.再血管化年代冠心病死亡原因分析[J].中华老年多器官疾病杂志,2020,19(12):919~924
再血管化年代冠心病死亡原因分析
Causes of deaths in patients with cardiovascular diseases in era of revascularization
投稿时间:2020-03-08  
DOI:10.11915/j.issn.1671-5403.2020.12.211
中文关键词:  冠心病;冠状动脉旁路手术;经皮冠状动脉介入;优化药物治疗;死亡率
英文关键词:coronary artery disease; coronary bypass grafting; percutaneous coronary intervention; optimized medical therapy; death rate Corresponding author:GAI Lu-Yue, E-mail:luyuegai@163.com〖FL
基金项目:
作者单位E-mail
盖兢泾 解放军总医院第一医学中心心血管内科,北京 100853 luyuegai@163.comcauses 
韩志奇 解放军总医院第一医学中心心血管内科,北京 100853 luyuegai@163.comcauses 
金琴花 解放军总医院第一医学中心心血管内科,北京 100853 luyuegai@163.comcauses 
盖鲁粤 解放军总医院第一医学中心心血管内科,北京 100853 luyuegai@163.comcauses 
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中文摘要:
      探讨再血管化年代冠心病死亡的原因。方法 连续入选解放军总医院第一医学中心心血管内科2008年1月至2014年1月行冠状动脉造影(CAG)的住院患者。依据CAG将患者分为3组:冠状动脉搭桥(CABG)组,优化药物治疗(OMT)组及经皮冠状动脉介入治疗(PCI)组。自2017年开始,采用电话随访、查阅既往住院病历随访或门诊随访。死亡事件为随访终点。分析所有死亡患者的死亡原因,并对3组间数据进行比较。应用SPSS 19.0软件对数据进行统计分析。结果 共入选1645例患者,随访中死亡113例。CABG组、OMT组及PCI组分别死亡28例(24.78%)、22例(19.47%)、63例(55.75%),差异无统计学意义(P>0.05)。各组死亡患者生前基础临床资料除Syntax积分外,其余指标差异均无统计学意义(均P>0.05)。CABG组、OMT组、PCI组死亡患者Syntax积分依次降低,分别为(33.45±17.89)分,(31.23±12.99)分,(21.35±11.65)分。死亡原因从高到低依次为:急性心肌梗死40例(35.40%),猝死21例(18.58%),癌症17例(15.04%),心力衰竭14例(12.39%),多器官衰竭11例(9.73%),脑血管死亡6例(5.31%),支架血栓3例(2.65%),出血1例(0.88%)。PCI组急性心肌梗死和猝死发生率明显高于其他2组,但差异无统计学意义(P>0.05)。将死亡事件分为非心血管死亡、迁延心血管死亡和意外死亡3类。非心血管死亡主要是癌症和脑血管意外,占21.23%;迁延心血管死亡主要包括心力衰竭和多器官衰竭,占22.12%;意外死亡主要包括急性心肌梗死、猝死和急性支架血栓,占56.64%。3类间差异无统计学意义(P>0.05)。结论 PCI后急性心肌梗死、猝死和支架血栓多见。癌症是第二位的死亡原因。多器官衰竭和心力衰竭预后很差。随着抗血小板药物、抗凝药物和溶栓药物的广泛应用,脑出血问题值得关注。
英文摘要:
      Objective To investigate the causes of death in patients with cardiovascular diseases in era of revascularization. Methods The consecutive patients were recruited in the study, who underwent coronary angiography (CAG) in the Department of Cardiology of Chinese PLA General Hospital from 2008 to 2014. They were divided into three groups based on CAG:the coronary artery bypass graft (CABG) group, the optimized medication (OMT) group, and the percutaneous coronary intervention (PCI) group. From 2017, they were followed up by telephone calls, case record screening and outpatient visits, the death being the endpoint of follow-up. The causes of all deaths were analyzed, and the three groups were compared. Statistical analysis was performed using SPSS statistics 19.0. Results Of the 1 645 patients recruited, 113 died during the follow-up, with 28 (24.78%) in CABG group, 22 (19.47%) in OMT group, and 63 (55.75%) in PCI group, and differences being not statistically significant (P>0.05). Except for the Syntax score, the basic clinical data of the deaths did not differ significantly among the three groups (P> 0.05). From the highest to the lowest, Syntax score was (33.45±17.89) points in CABG group, (31.23±12.99) points in OMT group, and (21.35±11.65) points in PCI group. The rate of death cause was, from the highest to the lowest, acute myocardial infarction 40 (35.40%), sudden death 21 (18.58%), cancer 17 (15.04%), heart failure 14 (12.39%), multiple organ failure 11 (9.73%), cerebrovascular accident 6 (5.31%), stent thrombosis 3 (2.65%), and bleeding 1(0.88%). The deaths caused by acute myocardial infarction and sudden death were higher in PCI group than in the other two groups, but the difference was not statistically significant (P>0.05). Non-cardiovascular deaths caused by cancer and cerebrovascular accidents accounted for 21.12%; delayed cardiovascular deaths caused by heart failure and multiple organ failure accounted for 22.1%; and accidental deaths including sudden deaths and those caused by acute myocardial infarction and acute stent thrombosis accounted for 56.6%, the differences being of no statistical significant difference (P>0.05). Conclusion Acute myocardial infarction, sudden death and stent thrombosis are common after PCI. Cancer ranked the second as the cause of death. The patients with multiple organ failure and heart failure had poor prognosis. With the widespread use of antiplatelet drugs, anticoagulants and thrombolytics, cerebral hemorrhage deserves attention.
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