■接受经皮冠状动脉介入治疗(PCI)的患者中有很大一部分没有标准的可改变的心血管危险因素(SMuRF):高血压,糖尿病,高胆固醇血症和吸烟。该分析的目的是根据SMuRFs的数量比较PCI后的临床结果。
■根据SMuRF的数量:0、1、2或3-4对具有PCI适应症的患者进行分层。主要结果是靶病变失败(TLF),心脏死亡的复合物,靶血管相关心肌梗死或临床驱动的靶病变1年血运重建。进行反向加权倾向评分(IWPS)调整以调整基线特征的差异。
■SMuRF的患病率为:0SMuRF16.4%;1SMuRF27.8%;2SMuRF34.7%和3-4SMuRF21.1%。没有SMuRF的患者更年轻,更有可能是男性,患有不太复杂的冠状动脉疾病。TLF的发生率随SMuRFs数量的增加而增加:2.65%,2.75%,3.23%,和4.24%,Ptrend<0.001。与没有SMuRF的患者相比,具有3-4个SMuRF的患者的TLF的相对风险(RR)高60%(95%置信区间1.32-1.93,p<0.01)。IWPS后趋势仍然存在(P趋势<0.01),TLF率为2.88%,2.64%,2.88%和3.65%。TLF的RR高出27%(95%CI1.05-1.53,p<0.01)。
■1年临床事件的发生率随着SMuRF数量的增加而增加。虽然没有SMuRF的患者具有相对有利的风险特征,需要更多的研究来优化大多数患者的治疗管理.
UNASSIGNED: A substantial proportion of the patients undergoing percutaneous coronary intervention (PCI) have none of the of standard modifiable cardiovascular risk factors (SMuRFs): hypertension, diabetes, hypercholesterolaemia and smoking. The aim of this analysis was to compare clinical outcomes after PCI according to the number of SMuRFs.
UNASSIGNED: Patients with an indication for a PCI were stratified based upon the number of SMuRFs: 0, 1, 2 or 3-4. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction or clinically driven target lesion revascularization at 1-year. Inverse weighted propensity score (IWPS) adjustment was performed to adjust for differences in baseline characteristics.
UNASSIGNED: The prevalence of SMuRFs was: 0 SMuRF 16.4 %; 1 SMuRF 27.8 %; 2 SMuRFs 34.7 % and 3-4 SMuRFs 21.1 %. Patients without SMuRFs were younger, more likely to be male and had less complex coronary artery disease. The incidence of TLF increased with the number of SMuRFs: 2.65 %, 2.75 %, 3.23 %, and 4.24 %, Ptrend < 0.001. The relative risk (RR) for a TLF was 60 % higher (95 % confidence interval 1.32-1.93, p < 0.01) for patients with 3-4 SMuRFs compared to patients without SMuRFs. The trend remained (Ptrend < 0.01) after IWPS with TLF rates of 2.88 %, 2.64 %, 2.88 % and 3.65 %. The RR for a TLF was 27 % higher (95 % CI 1.05-1.53, p < 0.01).
UNASSIGNED: The incidence of clinical events at 1-year increased with the number of SMuRFs. While patients without SMuRFs have a relatively favourable risk profile, more research is needed to optimize therapeutic management in the majority of patients.