Analysis Of Risk Factors For Patients With Revascularization Within 5 Years After PCI

Objective:Through the retrospective analysis of patients with coronary heart disease undergoing percutaneous coronary intervention(PCI),the risk factors affecting revascularization after PCI were screened to provide a reference for secondary prevention after clinical PCI.Methods:A retrospective analysis method was used to collect hospitalizations in the Department of Cardiovascular Medicine of the First Hospital of Jilin University from January 2018 to December 2019.A total of 141 patients were diagnosed with coronary heart disease and underwent PCI for the first time and underwent coronary angiography(CAG)in our hospital within 5 years.According to the results of CAG review,they were divided into two groups : reconstruction group(52 cases)and control group(89cases).T test,rank sum test,χ2 test and other statistical analysis methods were used to analyze the clinical data of the first hospitalization of the two groups of patients.Multivariate logistic regression analysis was performed again on the relevant data with statistical significance in the univariate analysis,and the receiver operating characteristic curve(ROC)was drawn.Results:1.Analysis of basic clinical data,laboratory examination indicators,postoperative medication and coronary artery characteristics of the two groups of patients :(1)The proportion of patients with smoking history and segmental wall motion abnormalities in the reconstruction group was higher than that in the control group(84.6 % VS 61.8 %,P = 0.004;38.5 % VS 20.2 %,P = 0.019).(2)The uric acid level of the reconstruction group was 377.5(288.25,440.75)higher than that of the control group 311(258,371),and the difference was statistically significant(P = 0.001).The left ventricular ejection fraction of the reconstruction group was 59(53.25,60)lower than that of the control group 60(58,62),and the difference was statistically significant(P = 0.003).In the postoperative dual antiplatelet therapy,the ratio of taking ticagrelor in the control group was higher than that in the reconstruction group,and the difference was statistically significant(24.7 %VS 5.8 %,P = 0.004).(3)The proportion of implanted stents ≧ 2,complete occlusion lesions and small vessel lesions in the reconstruction group was significantly higher than that in the control group(67.3 % VS 49.4 %,P = 0.039;55.8 % VS 38.2 %,P = 0.043;71.2 %VS 39.3 %,P = 0.000).The average level of coronary Gensini score in the reconstruction group was higher than that in the control group,and the difference was statistically significant(74.5(34.13,94.5)VS 51(25.5,81),P = 0.031).The complete revascularization rate in the control group was higher than that in the reconstruction group,and the difference was statistically significant(86.5 % VS 73.1 %,P = 0.047).2.Analysis of risk factors for revascularization within 5 years after PCI :The revascularization group was used as the dependent variable(defined as the control group = 0,the revascularization group = 1).The above single factor analysis P< 0.05 items(smoking,uric acid,left ventricular ejection fraction,wall segmental motion abnormalities,ticagrelor,small vessel disease)were used as independent variables for multivariate binary logistic regression analysis,and the above binary variables were assigned(smoking = 1,wall segmental motion abnormalities = 1,ticagrelor = 1,small vessel disease = 1,and the rest were 0).The results showed that smoking history,elevated uric acid and coronary small vessel disease were independent risk factors for revascularization after PCI,and taking ticagrelor after PCI was a protective factor for revascularization after PCI.3.Among the 52 patients who received PCI again,the proportion of non-target lesion revascularization(59.6 %)> the proportion of mixed revascularization(23.1 %)> the proportion of target lesion revascularization(17.3 %).3.The ROC curve of risk factors for revascularization within 5 years after PCI :According to the results of multivariate regression analysis,the ROC curve was drawn.The results showed that the area under the curve(AUC)of uric acid was 0.664(95 % CI : 0.565-0.763),the best cut-off value was 383.50 umol / L,the sensitivity was 0.481,and the specificity was 0.865.The area under the curve of smoking history was 0.614(95 % CI : 0.520-0.708),the sensitivity was 0.846,and the specificity was 0.382.The area under the curve of small vessel disease was 0.659(95 %CI : 0.566-0.752),the sensitivity was 0.712,and the specificity was 0.607.The area under the curve of ticagrelor was 0.595(95 % CI : 0.501-0.689),the sensitivity was0.942,and the specificity was 0.247.4.In the reconstruction group,the proportion of non-target lesion revascularization(59.6 %)> the proportion of mixed revascularization(23.1 %)> the proportion of target lesion revascularization(17.3 %).Conclusion:1.Combined smoking history,elevated uric acid,and coronary small vessel disease were independent risk factors for revascularization within 5 years after PCI.2.Postoperative administration of ticagrelor can reduce the rate of revascularization.3.The progression of non-target lesions is the main cause of revascularization within 5 years after PCI.