Determinates On Prognosis And Quality Of Life Following Percutaneous Coronary Intervention With Stent

Objectives: Coronary heart disease (CHD) is a severe chronic disease and the patients who suffered from CHD for a long time have poor quality of life. Moreover percutaneous coronary intervention with stent is very expensive and may lead to lots of complications in the operation or after the operation. Thus, doctors, the prognosis and the influential factors are becoming increasingly urgent. Then they can take the effective intervention to improve the prognosis. The aim of this research is to study the quality of life in patients undergoing percutaneous coronary intervention with stent and the prognosis of this operation. Furthermore, we also study determinates on prognosis and health-related quality of life of these patients so that we may supply a scientific evidence to improve the prognosis and quality of life of patients.Methods:All these 223 consecutive patients with coronary artery disease who successfully undergoing percutaneous coronary intervention with stent in the department of cardiology of Tangdu hospital from November, 2006 to August, 2007 were enrolled and a structured clinical questionnaire and the SF-36 quality of life questionnaire were used in this study. Moreover, we were following these patients for 6 months after they took the operations and required them to fill in the SF-36 quality of life questionnaire and visiting questionnaire. We obtained the data of quality of life and incidences of prognosis using cohort study method. We also analyzed determinates on prognosis and quality of life. The database was set up with SPSS13.0 and all the data were entered separately by two persons and inspected. SPSS13.0 soft wares were adopted to analyze the data, and the t test, correlation, multiple regression analysis, the X2 test, non-conditional logistic model were used in the statistical treatment.Results: 1. The quality of life of patients with coronary artery disease was significantly lower in all the eight variables of SF-36 compared with Americans and the people in Sichuan province(P<0.01). The scores of all variables except Vitality were significantly lower than the people in Hangzhou city(P<0.01). When we compared the quality of life by ages or sexes, scores of patients were also significantly lower than the scores of normal people. Determinates of quality of life are some factors about diseases(the number of stents implanted, other heart diseases, the time from having symptoms for the first time to entering the hospital, the number of days living in the hospital, the number of lesions, multiple lesions, single lesion, etc.), some factors about daily life(liking eating meat, vegetables, fruits and flour, drinking, smoking, and Body Mass Index, etc.), the history of psychic trauma, physical activity, sex and age. In this research, we obtained the data of QOL of people coming from the northwest China for the first time. We also analyzed determinates of quality of life in eight variables and work out regression equations.2.While we were following these patients after they were implanted stent, we found the quality of life in patients compared with the conditions before operations was significantly higher in all the eight variables of SF-36(P<0.01) and the total score of QOL. When we compared the patients'quality of life with normal people, scores of patients were also increasing. Determinates of the changes of QOL are some factors about diseases (the number of stents implanted, times of operation, other heart diseases, the time from having symptoms for the first time to entering the hospital, the days living in the hospital and the expense, hypertension, the type of CHD, the number of lesions, multiple lesions, single lesion, etc.), some factors about daily life (like eating meat, vegetables and drinking), some factors during following-up (physical activity, pain, revascularization, etc.), sex and age. We also worked out regression equations in eight variables.3.In the cohort study, the survival rate is 96.6%. Moreover, 39.9% and 41.9% of the patients had less pain or no pain. There were 19.7% of the patients who entered the hospital again. The incidence of in-stent restenosis and revascularization is 3.4% and 3.9% separately. The incidence of little activity and normal activity is 43.8% and 50.2% separately. On the contrary, there are only 2.5% of the patients lying in bed.The effect factors of bad prognosis are liking eating meat, single lesion, multiple lesion, living in the hospital again, revascularization. The RRs are 0.45, 0.23, 2.34, 5.85, 5.88. Moreover, compared with the patients whose SF-36 scores in Physical Functioning, Physical Functioning, Role- Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health, the scores are lower than that before operations and the incidence of bad prognosis in the patients whose scores are higher than before is lower. The RRs are 0.22, 0.09, 0.16, 0.11, 0.18, 0.39, 0.35, 0.21 separately.The outcomes of non-conditional logistic regression model indicated that the risk of bad prognosis in those who entered the hospital again, with raised scores in General Health or Vitality, and with small number of lesions was of 3.90, 0.14 ,0.16, and 0.61 times in contrast wtih those without the exposures.Conclusions: In this research, we obtained the data of QOL of people coming from the northwest China for the first time. We also analyzed determinates of quality of life in eight variables and worked out regression equations. Compared with the conditions before operations, the quality of life in patients was significantly higher in all the eight variables of SF-36. Determinates of the changes of QOL are some factors about diseases (the number of stents implanted, other heart diseases, the time from having symptoms for the first time to entering the hospital, the days living in the hospital and the expense, hypertension, the type of CHD, the number of lesions, multiple lesions, single lesion, etc.), some factors about daily life (like eating meat, vegetables and drinking), some factors during follow-up (physical activity, pain, revascularization, etc.), sex and age.In the cohort study, the survival rate is 96.6%. Moreover, 39.9% and 41.9% of the patients had less pain or no pain. There were 19.7% of the patients who entered the hospital again. The incidence of in-stent restenosis and revascularization is 3.4% and 3.9% separately. The incidence of little activity and normal activity is 43.8% and 50.2% separately. On the contrary, there are only 2.5% of the patients lying in bed. Determinates on prognosis are single lesion, multiple lesion, revascularization, liking eating meat, the changes of SF-36 scores in eight variables, etc.