Objective: To investigate the impact of coronary lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. Methods: In this prospective observational study, a total of 10 119 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention from January 1 to December 31, 2 103 in our hospital were enrolled. The patients were divided into non/mild calcification group (8 268 cases) and moderate/severe calcification group (1 851 cases) according to the angiographic results. The primary endpoint was one-year major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, and target vessel revascularization. Results: The patients were (58.3±10.3) years old, and there were 2 355 females (23.3%). Compared with non/mild calcification group, patients in the moderate/severe calcification group were older ((60.0±10.6) years vs. (57.9±10.2) years, P<0.01), and had higher proportion of female (25.4% (470/1 851) vs. 22.8% (1 885/8 268), P=0.02), debates (33.9% (628/1 851) vs. 29.0% (2 399/8 268), P<0.01), hypertension (68.0% (1 259/1 851) vs. 63.7% (5 264/8 268), P<0.01), coronary artery bypass grafting (4.6% (85/1 851) vs. 3.2% (268/8 268), P<0.01), stroke (12.6% (233/1 851) vs. 10.4% (861/8 268), P=0.01), and renal dysfunction (6.2% (115/1 851) vs. 3.7% (303/8 268), P<0.01). Compared with non/mild calcification group, patients in themoderate/severe calcification group experienced longer procedure time (37 (24, 61) min vs. 27 (17,40) min, P<0.01) and stent length was longer (32 (23,48) mm vs. 27 (18,38) mm, P<0.01), and percent of rotational atherectomy was higher (2.56%(57/2 229) vs. 0.03% (3/11 930), P<0.01). One-year follow-up results showed that MACE (7.5% (139/1 846) vs. 4.9% (402/8 243), P<0.01), all-cause death (1.0% (19/1 846) vs. 0.6% (49/8 243), P=0.04), myocardial infarction (2.2% (41/1 846) vs. 1.4% (114/8 243), P=0.01), and target vessel revascularization (5.0% (92/1 846) vs. 3.2% (266/8 243), P<0.01) were all significantly higher in moderate/severe calcification group than in non/mild group. Multivariate Cox regression analysis showed that moderate/severe calcification was an independent predictor of MACE at one-year after the procedure (HR=1.41, 95%CI 1.16-1.72, P<0.01). Conclusion: Moderate/severe calcification in coronary lesion is an independent predictor of long-term poor prognosis in coronary heart disease patients undergoing percutaneous coronary intervention.
目的： 探讨冠状动脉病变钙化程度对经皮冠状动脉介入治疗后冠心病患者远期预后的影响。方法： 采用前瞻性观察性研究方法，连续入选2013年1月1日至12月31日在阜外医院接受经皮冠状动脉介入治疗的冠心病患者10 119例。根据冠状动脉造影显示的靶病变钙化程度，将冠心病患者分为无/轻度钙化组（8 268例）和中/重度钙化组（1 851例）。主要研究终点为术后1年的主要不良心血管事件，包括全因死亡、心肌梗死和靶血管再次血运重建。结果： 入选患者年龄（58.3±10.3）岁，女性占23.3%（2 355例）。与无/轻度钙化组患者相比，中/重度钙化组患者年龄较大[（60.0±10.6）岁比（57.9±10.2）岁，P<0.01]，女性[25.4%（470/1 851）比22.8%（1 885/8 268），P=0.02]、糖尿病[33.9%（628/1 851）比29.0%（2 399/8 268），P<0.01]、高血压[68.0%（1 259/1 851）比63.7%（5 264/8 268），P<0.01]、冠状动脉旁路移植术史[4.6%（85/1 851）比3.2%（268/8 268），P<0.01]、卒中[12.6%（233/1 851）比10.4%（861/8 268），P=0.01]和肾功能不全史[6.2%（115/1 851）比3.7%（303/8 268），P<0.01]的比例均较高。与无/轻度钙化组患者相比，中/重度钙化组患者介入治疗操作时间和置入支架长度更长[分别为37（24，61）min比27（17，40）min，P<0.01；32（23，48）mm比27（18，38）mm，P<0.01]，接受旋磨治疗的比例更高[2.56%（57/2 229）比0.03%（3/11 930），P<0.01]。与无/轻度钙化组患者相比，中/重度钙化组患者术后1年发生主要不良心血管事件[7.5%（139/1 846）和4.9%（402/8 243），P<0.01]、全因死亡[1.0%（19/1 846）比0.6%（49/8 243），P=0.04]、心肌梗死[2.2%（41/1 846）比1.4%（114/8 243），P=0.01]和靶血管再次血运重建[5.0%（92/1 846）比3.2%（266/8 243），P<0.01]的比例均较高。多因素Cox回归分析显示，冠状动脉病变中/重度钙化是经皮冠状动脉介入治疗后患者发生主要不良心血管事件的独立危险因素（HR=1.41，95%CI 1.16~1.72，P<0.01）。结论： 冠状动脉病变中/重度钙化患者合并较多的高危临床因素。冠状动脉病变中/重度钙化是经皮冠状动脉介入治疗后冠心病患者远期预后不良的危险因素。.
Keywords: Coronary artery disease; Percutaneous coronary intervention; Prognosis.