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学科主题: 外科学
题名:
既往冠状动脉介入对冠状动脉旁路术早期结果的影响
作者: 钟鹏
答辩日期: 2016-05-17
导师: 王建业
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学第五临床医学院
学位: 博士
关键词: 冠状动脉旁路移植术 ; 经皮冠状动脉介入 ; 早期结果 ; 倾向得分匹配
其他题名: Impact of previous percutaneous coronary intervention on the early outcome of coronary artery bypass grafting
分类号: R541.4
摘要:

目的:分析既往经皮冠状动脉介入(PCI)治疗对冠状动脉旁路移植(CABG)术早期结果的影响。

方法:回顾性分析2010年12月至2015年12月在北京医院首次单纯行体外循环下CABG的320例患者临床资料,根据患者既往是否行PCI分为PCI组(n=50)和非PCI组(n=270)。为了控制选择的偏倚,基于16项患者特征和术前危险因素进行1:1倾向得分匹配。非校正单因素和风险校正多因素logistic回归分析用来评价患者既往PCI对CABG术后住院死亡和总住院并发症的影响。

结果:与非PCI患者相比,既往PCI患者吸烟比例高(P=0.039),左室射血分数(LVEF)低(P=0.032),移植静脉桥数少(匹配前,2.5±0.7 vs 2.7±0.7,P=0.029;匹配后,2.6±0.7 vs 2.9±0.7,P=0.026)。两组间住院死亡率(匹配前,4.0% vs 1.9%,P=0.669;匹配后,2.2% vs 2.2%,P=1.000)和总住院并发症(匹配前,22% vs 24.8%,P=0.670;匹配后,22.2% vs 15.6%;P=0.419)无显著性差异。多因素logistic回归分析提示女性(OR,5.53;CI,1.11-27.6;P=0.037)、年龄(OR,1.15;CI,1.01-1.30;P=0.038)、LVEF(OR,0.94;CI,0.89-10;P=0.038)是住院死亡的独立预测因素,年龄(OR,1.04;CI,1.01-1.06;P=0.019)是总住院并发症的独立预测因素。既往PCI在单因素logistic回归模型中既不是住院死亡(OR,2.21;CI,0.42-11.71;P=0.352)也不是总住院并发症(OR,0.89;CI,0.45-1.73;P=0.722)的独立预测因素,强制使既往PCI与其他独立预测因素按前进逐步法进入多因素logistic回归模型,亦提示既往PCI不是二者的独立预测因素。

结论:既往PCI不是患者首次单纯行体外循环下CABG术后住院死亡和总住院并发症的独立预测因素,女性、年龄及LVEF是住院死亡的独立预测因素,年龄是总住院并发症的独立预测因素;与非PCI患者相比,既往PCI患者首次单纯行体外循环下CABG,移植静脉桥数更少。

 

英文摘要:

 

Objective: To investigate the impact of previous percutaneous coronary intervention (PCI) on the early outcome of patients undergoing first-time isolated on-pump coronary artery bypass grafting (CABG).

Methods: We retrospectively analyzed 320 consecutive patients who underwent first-time isolated on-pump CABG in Beijing hospital from December 2010 to December 2015. Patients were stratified into two groups: with previous PCI (n=50) and without previous PCI (n=270). To control ion bias, a computed propensity-score 1:1 matching based on 16 patient acteristics and preoperative risk factors was performed. Unadjusted univariate and risk-adjusted multivariate logistic regression models were used to assess the impact of previous PCI on in-hospital mortality and composite hospital morbidity.

Results: Patients with previous PCI had higher smoker ratio (P=0.039), lower left ventricular ejection fraction (LVEF, P=0.032) and less venous grafts (before matching, 2.5 ± 0.7 vs 2.7 ± 0.7, P=0.029; after matching, 2.6 ± 0.7 vs 2.9 ± 0.7, P=0.026). There was no statistically significant difference in in-hospital mortality (before matching, 4.0% vs 1.9%, P=0.669; after matching, 2.2% vs 2.2%, P=1.000) or composite hospital morbidity (before matching, 22% vs 24.8%, P=0.670; after matching, 22.2% vs 15.6%, P=0.419) between the two groups. Risk-adjusted multivariate logistic regression analysis revealed that female (OR, 5.53; CI, 1.11-27.6; P=0.037), age (OR, 1.15; CI, 1.01-1.30; P=0.038), LVEF (OR, 0.94; CI, 0.89-10; P=0.038) were the independent predictors of in-hospital mortality, and age (OR, 1.04; CI, 1.01-1.06; P=0.019) was also an independent predictor of composite hospital morbidity. However, previous PCI was neither an independent predictor of in-hospital mortality (OR, 2.21; CI, 0.42-11.71; P=0.352) nor composite hospital morbidity (OR, 0.89; CI, 0.45-1.73; P=0.722) in the univariate logistic regression analysis and multivariate logistic regression analysis confirmed it.

Conclusions: Previous PCI was neither an independent predictor of the in-hospital mortality nor composite hospital morbidity of the patients who underwent first-time isolated on-pump CABG; Female, age and LVEF were the independent predictors of in-hospital mortality, and age was also an independent predictor of composite hospital morbidity; Patients with previous PCI had less venous grafts when underwent first-time isolated on-pump CABG.

 

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124790
Appears in Collections:北京大学第五临床医学院_学位论文

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作者单位: 北京大学第五临床医学院

Recommended Citation:
钟鹏. 既往冠状动脉介入对冠状动脉旁路术早期结果的影响[D]. 北京大学第五临床医学院. 北京大学. 2016.
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