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目的分析冠状动脉粥样硬化性心脏病(CHD)家族史阳性患者经皮冠状动脉介入治疗(PCI)的预后。方法选取在医院行PCI术且伴CHD家族史患者1072例为阳性组,随机抽取同期行PCI术且CHD家族史阴性患者1000例为阴性组。收集基线资料包括年龄、性别、体质指数(BMI)和冠心病危险因素(吸烟、糖尿病、高血压、高脂血症)。平均随访时间1~120(59.0±23.7)月,随访终点为心源性死亡和全因死亡事件。通过Kaplan-Meier法记录生存曲线,通过COX多因素回归法分析影响预后的独立预测因素。结果 CHD家族史阳性组患者的BMI、糖尿病和高血压病的发病率与阴性组无显著差异(P>0.05);发病年龄、吸烟率显著低于阴性组,而男性比例、高脂血症发病率显著高于阴性组,差异均有统计学意义(P<0.05)。COX多因素回归分析显示:CHD家族史和他汀类药物是PCI患者心源性死亡和全因死亡事件的独立保护因素,而高龄是全因死亡的独立危险因素。Kaplan-Meier生存曲线示CHD家族史阳性组患者PCI全因死亡生存率和心源性死亡生存率均显著高于阴性组患者。结论阳性CHD家族史是患者PCI预后的独立保护性因素,这类患者PCI术后预后优于阴性者。
Objective To analyze the prognosis of patients with positive family history of coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI). Methods A total of 1072 patients with family history of CHD who underwent PCI in our hospital were selected as the positive group. One hundred and thirteen patients with negative CHD family history were randomly selected as the negative group. Baseline data collected included age, sex, body mass index (BMI), and risk factors for coronary heart disease (smoking, diabetes, hypertension, hyperlipidemia). The average follow-up time ranged from 1 to 120 (59.0 ± 23.7) months. The end point of follow-up was cardiogenic death and all-cause death. Survival curves were recorded by Kaplan-Meier method and independent prognostic predictors were analyzed by COX multivariate regression. Results There was no significant difference in the incidence of BMI, diabetes and hypertension between the CHD positive group and the negative group (P> 0.05), the age of onset and the smoking rate were significantly lower than those in the negative group, while the male ratio, the incidence of hyperlipidemia The rate was significantly higher than the negative group, the difference was statistically significant (P <0.05). COX multivariate regression analysis showed that family history of CHD and statins were independent protective factors of cardiogenic death and all-cause mortality in PCI patients, while aging was an independent risk factor of all-cause mortality. The Kaplan-Meier survival curves showed that all patients with positive CHD family history of PCI had significantly higher survival rates of all-cause and cardiac death than those in the negative group. Conclusion The positive family history of CHD is an independent protective factor in patients with prognosis of PCI, such patients after PCI prognosis is better than negative.