Analysis Of Risk Factors For Revascularization After Percutaneous Coronary Invention Of Acute Coronary Syndrome

Background and objective: Percutaneous coronary invention(PCI) has been widely used in the therapy of coronary heart disease(CHD) and obviously improves the outcome of acute coronary syndrome(ACS) patients. However, there are still many patients get clinical symptoms of CHD after successful PCI, then they have to receive second revascularization. The purpose of this retrospective study is to investigate the risk factors of revascularization.Method: 510 patients undergoing CAG in the first affiliated hospital of dalian medical university from 2010.1 to 2014.8 are accepted. 409 patients of them are received revascularization and we save the clinical material of the first and second PCI for the patients who received several times of PCI. 101 patients are received coronary angiography(CAG) that shows no coronary lesions and restenosis. We estimate the baseline charactaristics(age, sex, etal),cardiovascular risk factor(hypertension, DM,etal), blood test indicators, ultrasonic cardiogram of two groups. Then we divided patients received revascularization into target lesion group(TLR), target vessel group(TVR), non-target vessel group(NTVR), mixed lesion group(MLR) according to the way of revascularization. Continuous variables in subgroups are analyzed by Student t test, variance analysis is used in multiple group comparison, categorical variables are analyzed by Chi square test, logistic analysis is used to analyze multivariate analysis.The P<0.05 is significant in statistics.Result: In revascularization group, mean age was 59.75±10.34,male 328(80.2%),and in control group, mean age is 60.20±10.18, male 81(80.2%).Referred to first PCI,direct PCI patients(12.2%VS2.9%,P=0.029)and DM%(37.7%VS27.7%,P=0.039)of revascularization group were higher statistically,and age, sex, smoking, smoking index, HP%, TC, TG, HDL, LDL, LPa, apolipoprotein A, apolipoprotein B, cardiacfunction(EF,LVDD), CAG result were all statistically insignificant between two groups.In the second PCI, LPa(271.74±247.75mg/l VS 213.59±192.09mg/l,P=0.040)、LDL-C( 95.97±29.84mg/dl VS 87.30±26.78mg/dl, P=0.011) were higher and EF(54.98±7.79%VS 56.62±6.13%,P=0.040)、the substandard LDL-C(≤100mg/dl)%(61.7% VS 71.7%,P=0.044)was lower in revascularization group. The interval from first PCI to second CAG, substandard TC(≥160mg/dl) were the independent risk factors for revascularization after PCI. In the subgroups, patients of TVR were significantly older than other groups, substandard LDL% of NTVR and MLR were significant higher than controls.Conclusion:(1) This study indicates that DM, longer interval from first PCI to second CAG, substandard LDL and higher LPa may aggravate the coronary lesions.(2)Substandard TC after first PCI and the interval from first PCI to second CAG are independent risk factors of revascularization.(3) It’s necessary to control cardiovascular risk factors after PCI, especially DM and lipidemia so to avoid revascularization.