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目的了解影响老年冠心病患者血运重建术后死亡的危险因素。方法在药物洗脱支架对血运重建影响研究(DESIRE)数据库中,入选2003年7月1日至2004年6月30日在我院接受冠状动脉血运重建术,年龄70岁以上,出院后随访>30天的冠心病患者675例,男性498例,女性177例。记录患者的临床特点、随访期间死亡和主要不良心脑血管事件(MACCE)发生情况。结果平均随访(754±355)天。随访中死亡27例(4.0%),发生 MACCE 50例(7.4%),多因素 Cox 回归分析,校正其他因素后,与男性患者相比,女性患者死亡的危险为2.750(95% CI 1.116～6.779,P=0.028);合并贫血患者死亡危险为0.385(95% CI 0.164～0.904,P=0.028);血肌酐(Cr)水平越高,死亡危险越大,肾功能减低者(Cr≥115μmol/L)死亡危险为2.963(95% CI 1.114～9.952,P=0.035),肾功能不全者(Cr≥177μmol/L)死亡危险为10.785(95% CI 2.659～78.097,P=0.000)。结论影响血运重建后老年冠心病患者死亡的危险因素是性别、血运重建前血红蛋白和 Cr 水平。女性、贫血和肾功能减低的冠心病患者血运重建后远期预后不良,死亡率高。术前应认识这些危险因素并加以纠正,将有利于改善血运重建后老年冠心病患者的远期预后。
Objective To understand the risk factors of death after revascularization in elderly patients with coronary heart disease. Methods In the DESIRE database, the patients undergoing coronary revascularization in our hospital from July 1, 2003 to June 30, 2004 were over 70 years old. After discharged from hospital, Follow-up> 30 days of 675 cases of coronary heart disease patients, 498 males and 177 females. The patient’s clinical characteristics, deaths during follow-up, and major adverse cardiac events (MACCE) were recorded. Results The average follow-up (754 ± 355) days. Mortality in women was 2.750 (95% CI, 1.116 to 6.779) compared with male patients after adjusting for other factors, including 27 deaths (4.0%) at follow-up, MACCE 50 (7.4%), and multivariate Cox regression analysis , P = 0.028). The risk of death in patients with anemia was 0.385 (95% CI 0.164-0.904, P = 0.028). The higher the level of serum creatinine (Cr), the greater the risk of death and the lower the renal function (Cr≥115μmol / L ) Had a risk of death of 2.963 (95% CI 1.114-9.952, P = 0.035). The risk of death from renal failure (Cr ≥177 μmol / L) was 10.785 (95% CI 2.659-78.097, P = 0.000). Conclusions The risk factors of death in elderly patients with coronary heart disease after revascularization are gender, hemoglobin and Cr levels before revascularization. Women with anemia and impaired renal function have long-term poor prognosis and high mortality after revascularization. Preoperative understanding of these risk factors and to be corrected, will help improve the long-term prognosis of elderly patients with coronary heart disease after revascularization.